Basic Information
| Provider Information | |||||||||
| NPI: | 1720387061 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | JACOB | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 CREEKSIDE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341082068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395949100 | ||||||||
| FaxNumber: | 2395943054 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 CREEKSIDE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341082068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395949100 | ||||||||
| FaxNumber: | 2395943054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2011 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125.059766 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208200000X | ME134603 | FL | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.