Individual
TOSHEIBA MISTIQUE HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1101 ERASTE LANDRY RD, LAFAYETTE, LA 70506-3043
(337) 289-6690
Mailing address
7541 CAPRISTA AVE, BATON ROUGE, LA 70811
(337) 289-6690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD026036
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA STATE LICENSE
MD026036
LA
05
—
PENDING
—
LA
Enumeration date
08/14/2006
Last updated
07/08/2007
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