Provider Demographics
NPI:1043205669
Name:HOLCOMBE, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:HOLCOMBE
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 1:1300 MICCOSUKEE ROAD
Mailing Address - Street 2:BIXLER EMERGENCY CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-0911
Mailing Address - Fax:850-431-0779
Practice Address - Street 1:1309 THOMASVILLE ROAD
Practice Address - Street 2:PHYSICIAN BILLING OFFICE
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-431-7289
Practice Address - Fax:850-431-6975
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049405207P00000X
FLME119322207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52821815018OtherBCBS
GA338048OtherWELLCARE
GA056005018BMedicaid
GA52821815-019OtherBCBS
GA930103245OtherRAILROAD MEDICARE
GA000892383AMedicaid
GA056005018CMedicaid
GA000892383AMedicaid
GA056005018CMedicaid
GA93BBJSTMedicare PIN