Individual
JED D HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7111 E 21ST STREET N, SUITE A, WICHITA, KS 67206
(316) 684-2851
(316) 686-7338
Mailing address
7111 E 21ST STREET N, SUITE A, WICHITA, KS 67206
(316) 684-2851
(316) 686-7338
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-18241
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100084320B
—
KS
05
—
100416440A
—
KS
01
—
101601
BLUE CROSS INDIVIDUAL
KS
01
—
110718
BLUE CROSS GROUP
KS
01
—
621541
FIRSTGUARD
IA
01
—
80186351
RAILROAD MEDICARE
KS
Enumeration date
06/01/2005
Last updated
10/16/2012
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