Provider Demographics
NPI:1992870836
Name:HOLMES, THOMAS STEPHENSON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEPHENSON
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:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0816
Mailing Address - Country:US
Mailing Address - Phone:208-743-2511
Mailing Address - Fax:208-799-5554
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2431
Practice Address - Country:US
Practice Address - Phone:208-743-2511
Practice Address - Fax:208-799-5554
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-95142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7046543Medicaid
IDHPAC4OtherBLUE CROSS OF IDAHO
ID10154124OtherREGENCE OF IDAHO
WA8455685Medicaid
ID8858407Medicare ID - Type UnspecifiedNORIDIAN MEDICARE
IDHPAC4OtherBLUE CROSS OF IDAHO
ID1132506Medicare ID - Type UnspecifiedCIGNA MEDICARE
WA8455685Medicaid