Provider Demographics
NPI:1982642229
Name:HOLMES, JOSHUA JAN (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAN
Last Name:HOLMES
Suffix:
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 1:851 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-2941
Mailing Address - Country:US
Mailing Address - Phone:970-625-0842
Mailing Address - Fax:970-625-3706
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2941
Practice Address - Country:US
Practice Address - Phone:970-625-0842
Practice Address - Fax:970-625-3706
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01236777Medicaid
CO01236777Medicaid
CO42761Medicare ID - Type Unspecified