Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | F9578 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | F9578 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | F9578 | TX |
NPI | 1073560744 |
---|---|
Provider Name | Peter F Holmes |
First Address | San Antonio, TX 78240-1558 |
Second Address | San Antonio, TX 78240-1558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4056366 | AETNA ID NUMBER (01) | |
C17054 | (02) |