Provider Demographics
NPI:1538129911
Name:HOLMBERG, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:HOLMBERG
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:PO BOX 814129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-4129
Mailing Address - Country:US
Mailing Address - Phone:972-906-6250
Mailing Address - Fax:972-906-0116
Practice Address - Street 1:405 STATE HIGHWAY 121 BYP
Practice Address - Street 2:BLDG A, STE 160
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8193
Practice Address - Country:US
Practice Address - Phone:972-906-6250
Practice Address - Fax:972-906-0116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82R575Medicare ID - Type Unspecified
E79512Medicare UPIN