Provider Demographics
NPI:1588791677
Name:HOLCOMB, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11797 SOUTH FREEWAY
Mailing Address - Street 2:ASSESSMENT CENTER
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0337
Mailing Address - Country:US
Mailing Address - Phone:817-551-2560
Mailing Address - Fax:817-551-2561
Practice Address - Street 1:11797 SOUTH FREEWAY
Practice Address - Street 2:ASSESSMENT CENTER
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-0337
Practice Address - Country:US
Practice Address - Phone:817-551-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD82692083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17016Medicare UPIN