Basic Information
| Provider Information | |||||||||
| NPI: | 1275590333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 S CASCADE ST | ||||||||
| Address2: | |||||||||
| City: | FERGUS FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565372913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187368000 | ||||||||
| FaxNumber: | 2186857292 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 STATE HWY 79 EAST | ||||||||
| Address2: | |||||||||
| City: | ELBOW LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186857300 | ||||||||
| FaxNumber: | 2186857292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37994 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.