Provider Demographics
NPI:1104975523
Name:HOLCK, BARBARA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:HOLCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 YERBA SANTA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-2407
Mailing Address - Country:US
Mailing Address - Phone:702-654-3383
Mailing Address - Fax:
Practice Address - Street 1:99 MDOS SGOPF
Practice Address - Street 2:MOFH
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6601
Practice Address - Country:US
Practice Address - Phone:702-654-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1101207Q00000X
CA20A5195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
57396Medicare ID - Type Unspecified
CAG36973Medicare UPIN