Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD60657280 | WA |
N | 2081P2900X | Pain Medicine | 0101252225 | VA |
Y | 2081P2900X | Pain Medicine | MD60657280 | WA |
NPI | 1073815163 |
---|---|
Provider Name | Dr. Samuel Lawrence Holmes |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2010 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2162033 | (05) | WA |