Provider Demographics
NPI:1063526309
Name:HOLCOMB, DONALD (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 STONY FORD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7235
Mailing Address - Country:US
Mailing Address - Phone:214-212-0234
Mailing Address - Fax:
Practice Address - Street 1:4936 STONY FORD DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7235
Practice Address - Country:US
Practice Address - Phone:214-212-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099842902Medicaid
TX099842902Medicaid
TXA67103Medicare UPIN