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Individual
JEFFREY J HOLMSTROM
Active
Individual
JEFFREY J HOLMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1099
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003678
ANTHEM
ME
01
—
080190067
MEDICARE RR
ME
05
—
293270099
—
ME
01
—
30224338
EDS NH MEDICAID
NH
05
—
30224338
—
NH
01
—
B82880
HARVARD
ME
01
—
M107799
CIGNA
ME
01
—
MM4279
MEDICARE CLASS
ME
Enumeration date
12/19/2005
Last updated
05/05/2008
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