Provider Demographics
NPI:1518130624
Name:HOLMES, JORDAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name: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 1:8901 INDIAN HILLS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4032
Mailing Address - Country:US
Mailing Address - Phone:402-397-7057
Mailing Address - Fax:
Practice Address - Street 1:8901 INDIAN HILLS DR STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4032
Practice Address - Country:US
Practice Address - Phone:402-397-7057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31417207RG0100X
KS04-38815207RG0100X
390200000X
AZ50252390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program