Provider Demographics
NPI:1477550051
Name:HOLMES, J MELBURN D (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:MELBURN D
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 MAIN ST.
Mailing Address - Street 2:J MELBURN D. HOLMES
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-0665
Mailing Address - Country:US
Mailing Address - Phone:334-863-2311
Mailing Address - Fax:334-863-5596
Practice Address - Street 1:1950 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-2421
Practice Address - Country:US
Practice Address - Phone:334-863-2311
Practice Address - Fax:334-863-5596
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009079208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL410013859OtherRAILROAD MEDICARE
AL051555463Medicaid
AL51000500OtherBLUE CROSS OF ALABAMA
AL51555463Medicare PIN
AL051555463Medicaid