Provider Demographics
NPI:1124099437
Name:HOLCOMB, THOMAS J III (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HOLCOMB
Suffix:III
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 1:427 COLUMBIA POINT DR.
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4373
Mailing Address - Country:US
Mailing Address - Phone:901-299-9644
Mailing Address - Fax:
Practice Address - Street 1:888 SWIFT BLVD.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3514
Practice Address - Country:US
Practice Address - Phone:509-942-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16236207L00000X
WA60187979207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00095885Medicaid
AR92418OtherBLUECROSS BLUESHIELD
50046018OtherMEDICARE TRAVELERS
TN3014312Medicaid
AR112943001Medicaid
MO203461900Medicaid
TN3072113OtherBLUECROSS BLUESHIELD
TN3014312Medicaid
50046018OtherMEDICARE TRAVELERS