Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 78-183 | NM |
N | 207ND0900X | Dermatopathologist | 78-183 | NM |
N | 207NP0225X | Pediatric Dermatologist | 78-183 | NM |
N | 207NS0135X | Procedural Dermatology | 78-183 | NM |
NPI | 1003844259 |
---|---|
Provider Name | Dr. Thomas Matthew Holmes |
First Address | Santa Fe, NM 87505-7670 |
Second Address | Santa Fe, NM 87505-7670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11038668 | CAQH-UNITED (01) | NM |
17187 | PRESBYTERIAN (01) | NM |
24604 | (05) | NM |
D35713 | (02) | NM |