Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | C01090 | AR |
NPI | 1003803560 |
---|---|
Provider Name | Mr. David John Holmes |
First Address | Conway, AR 72034-4967 |
Second Address | Conway, AR 72034-4967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 08/07/2007 |