Individual
JEFFREY J HOLMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
655 MAIN ST, SACO, ME 04072-1543
(207) 283-1407
(207) 284-6291
Mailing address
655 MAIN ST, SACO, ME 04072-1543
(207) 283-1407
(207) 284-6291
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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