Provider Demographics
NPI:1154383958
Name:HOLMES, ADELE B (MD)
Entity type:Individual
Prefix:DR
First Name:ADELE
Middle Name:B
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 SPRINGHILL ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019
Mailing Address - Country:US
Mailing Address - Phone:501-315-0078
Mailing Address - Fax:501-943-3016
Practice Address - Street 1:2301 SPRINGHILL ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019
Practice Address - Country:US
Practice Address - Phone:501-315-0078
Practice Address - Fax:501-943-3016
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5902223OtherAETNA PROVIDER ID
AR129511001Medicaid
AR5K100OtherBCBS PRIVIDER ID
AR1220059OtherUNITED HEALTH CARE ID#
AR16838000000OtherQUALCHOICE PRIOVIDER ID
AR5K100OtherBCBS PRIVIDER ID