Basic Information
| Provider Information | |||||||||
| NPI: | 1386611432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 KINGS FAIRWAY CT | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484398677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106944617 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 HURLEY PLZ | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102627300 | ||||||||
| FaxNumber: | 8102627243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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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 | 207V00000X | 4301059336 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3255943 | 05 | MI | MEDICAID |