Provider Demographics
NPI:1568469302
Name:HOLMES, DAVID L (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4716
Mailing Address - Country:US
Mailing Address - Phone:863-676-0014
Mailing Address - Fax:863-676-0090
Practice Address - Street 1:455 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4716
Practice Address - Country:US
Practice Address - Phone:863-676-0014
Practice Address - Fax:863-676-0090
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS006024207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE34977Medicare UPIN
FLK8529Medicare PIN