Provider Demographics
NPI:1306926308
Name:HOLMES, MARK DAVID
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:HARBORVIEW MEDICAL CENTER
Practice Address - Street 2:325 9TH AVE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-9745
Practice Address - Country:US
Practice Address - Phone:206-731-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000288692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306926308Medicaid
WA0231224OtherL&I
9686OtherINTERNAL ID-MOTOR VEHICLE ID
9686OtherINTERNAL ID-MOTOR VEHICLE ID
C36965Medicare UPIN