Provider Demographics
NPI:1578899134
Name:HOLMES, FREDERICK FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:FRANKLIN
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 1:4701 BLACK SWAN DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1234
Mailing Address - Country:US
Mailing Address - Phone:913-631-0952
Mailing Address - Fax:
Practice Address - Street 1:4701 BLACK SWAN DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1234
Practice Address - Country:US
Practice Address - Phone:913-631-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-14113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine