Organization Name: | J MELBURN D HOLMES |
NPI Number: | 1326220591 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN M HOLMES (OWNER) |
Mailing Address: | 32 Medical Dr Ste 7 Roanoke |
State: | AL US |
Postal Code: | 362742421 |
Phone Number: | 3348635262 |
Fax Number: | 3348635264 |
NPI Enumeration Date: | 11/29/2007 |
NPI Last Update Date: | 01/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |