Provider Demographics
NPI:1528460607
Name:HOLMAN, JOHN MILLER JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MILLER
Last Name:HOLMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W WRIGHTWOOD AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1290
Mailing Address - Country:US
Mailing Address - Phone:773-388-2297
Mailing Address - Fax:
Practice Address - Street 1:4765 S ICHABOD ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6461
Practice Address - Country:US
Practice Address - Phone:801-231-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163812-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist