Provider Demographics
NPI:1104895655
Name:HOLMES, MARGARET B (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:B
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:B
Other - Last Name:FUGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:1720 MESQUITE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5602
Practice Address - Country:US
Practice Address - Phone:925-854-3333
Practice Address - Fax:928-854-3335
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1445363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ135758Medicaid
AZZP00405845Medicare PIN
AZZ108125Medicare PIN
R09345Medicare UPIN