Provider Demographics
NPI:1124056197
Name:HOLMES, DENNIS R (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5670 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1740
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:714-522-2001
Mailing Address - Fax:714-522-7503
Practice Address - Street 1:1513 S. GRAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-5324
Practice Address - Country:US
Practice Address - Phone:213-742-5784
Practice Address - Fax:213-742-6055
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA68940208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A689400OtherBLUE SHIELD PIN
CA00A689400Medicaid
CA020053128OtherMEDICARE RAILROAD
CA00A689400Medicaid
CABU228ZMedicare PIN
CA020053128OtherMEDICARE RAILROAD