Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | BP10048824 | TX |
Y | 207Q00000X | Family Doctor | BP10048824 | TX |
NPI | 1174930408 |
---|---|
Provider Name | Kevin Holmewood |
First Address | Fort Worth, TX 76115-2945 |
Second Address | Fort Worth, TX 76107-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2014 |
Last Update Date | 18/07/2014 |