Provider Demographics
NPI:1932505807
Name:HOLMES, JEROME III
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:HOLMES
Suffix:III
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 1:3855 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3045
Mailing Address - Country:US
Mailing Address - Phone:918-743-4768
Mailing Address - Fax:
Practice Address - Street 1:3855 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3045
Practice Address - Country:US
Practice Address - Phone:918-743-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator