Provider Demographics
NPI:1770849671
Name:HOLMAN, KEVIN JUDE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JUDE
Last Name:HOLMAN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7100 REDWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4110
Mailing Address - Country:US
Mailing Address - Phone:415-492-1600
Mailing Address - Fax:415-492-1688
Practice Address - Street 1:7100 REDWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:415-492-1600
Practice Address - Fax:415-492-1688
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant