Provider Demographics
NPI:1720041031
Name:HOLMES, EDWIN R III (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:R
Last Name:HOLMES
Suffix:III
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 1:1314 S GRAND BLVD STE 2-315
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1174
Mailing Address - Country:US
Mailing Address - Phone:509-999-7654
Mailing Address - Fax:
Practice Address - Street 1:1314 S GRAND BLVD STE 2-315
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1174
Practice Address - Country:US
Practice Address - Phone:509-999-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000171832085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA15741Medicare UPIN