Provider Demographics
NPI:1013088525
Name:HOLMES, BEVERLY A (DO)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DO
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 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1307 S MAIN ST
Practice Address - Street 2:ROUTE 3, BOX 25
Practice Address - City:LOCKWOOD
Practice Address - State:MO
Practice Address - Zip Code:65682-8327
Practice Address - Country:US
Practice Address - Phone:417-232-4560
Practice Address - Fax:417-232-4611
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8N33207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242929701Medicaid
MOE15980Medicare UPIN
MO242929701Medicaid
MO329013268Medicare PIN