Individual
ERNEST SAMUEL HOLMES IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
336 S JEFFERSON ST, NEOSHO, MO 64850-1769
(417) 451-0778
(417) 451-0779
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 451-0778
(417) 451-0779
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
115096
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100149160A
—
OK
05
—
100317780A
—
KS
01
—
115234
ANTHEM
MO
05
—
203756804
—
MO
Enumeration date
07/03/2006
Last updated
02/17/2011
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