Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 201191 | LA |
NPI | 1003007998 |
---|---|
Provider Name | William D. Holmes JR. |
First Address | Luling, LA 70070-4442 |
Second Address | Luling, LA 70070-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 28/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1444642 | (05) | LA |
1479322 | (05) | LA |