Provider Demographics
NPI:1629026141
Name:HOLMES, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 COFFEE RD
Mailing Address - Street 2:#100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3192
Mailing Address - Country:US
Mailing Address - Phone:209-524-4438
Mailing Address - Fax:209-524-7395
Practice Address - Street 1:1335 COFFEE RD
Practice Address - Street 2:#100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3192
Practice Address - Country:US
Practice Address - Phone:209-524-4438
Practice Address - Fax:209-524-7395
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG81678207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG816780Medicaid
CAOOG816780Medicare ID - Type Unspecified
G82481Medicare UPIN