Provider Demographics
NPI:1790285823
Name:HOLMES, DESMOND HOLMES D
Entity Type:Individual
Prefix:
First Name:DESMOND HOLMES
Middle Name:D
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 SUNNY LANE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3723
Mailing Address - Country:US
Mailing Address - Phone:216-904-2879
Mailing Address - Fax:
Practice Address - Street 1:5650 SUNNY LANE RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3723
Practice Address - Country:US
Practice Address - Phone:216-904-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program