Provider Demographics
NPI:1215940168
Name:HOLMES, PAUL WEBER (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WEBER
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1850 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-6100
Mailing Address - Country:US
Mailing Address - Phone:530-257-5563
Mailing Address - Fax:530-257-6015
Practice Address - Street 1:1850 SPRING RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-6100
Practice Address - Country:US
Practice Address - Phone:530-257-5563
Practice Address - Fax:530-257-6015
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG43203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080042465OtherRRMCR HOLMES
080042465OtherRRMCR HOLMES
942492609OtherTAX ID NUMBER