Provider Demographics
NPI:1992236269
Name:HOLMES, BRANDON BLAKE (MD/PHD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:BLAKE
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 SCOTT AVE
Mailing Address - Street 2:# 620
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1031
Mailing Address - Country:US
Mailing Address - Phone:281-216-0328
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE # M-798
Practice Address - Street 2:BOX 0114
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program