Provider Demographics
NPI:1174576953
Name:HOLMES, STEPHEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:DEPT 60281
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-591-1504
Mailing Address - Fax:808-591-1506
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-591-1504
Practice Address - Fax:808-591-1506
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-42042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI003882Medicaid
HIMD4204-02OtherMDX HAWAII
CAXPY187074OtherMEDI-CAL
HI003882Medicaid
HIMD4204-02OtherMDX HAWAII