Provider Demographics
NPI:1952382624
Name:HOLMES, DAVID W (AUD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:HOLMES
Suffix:
Gender:M
Credentials:AUD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 RANA PARK
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-8824
Mailing Address - Country:US
Mailing Address - Phone:817-201-6791
Mailing Address - Fax:
Practice Address - Street 1:2083 RANA PARK
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-8824
Practice Address - Country:US
Practice Address - Phone:817-201-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50468231HA2400X, 231HA2500X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHAID 009444Medicaid
TXR60023Medicare UPIN
TX517038Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
0025SMedicare PIN
TX80101AMedicare ID - Type UnspecifiedINDIVIDUAL # IN GROUP