Provider Demographics
NPI:1881867737
Name:HOLMQUIST, BRENT P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:P
Last Name:HOLMQUIST
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:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:10109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5554
Practice Address - Country:US
Practice Address - Phone:402-572-3500
Practice Address - Fax:402-572-3505
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098684135OtherMEDICARE PTAN