Provider Demographics
NPI:1093025934
Name:HOLCOMBE, DAVID SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:HOLCOMBE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MACKENZIE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:SD
Mailing Address - Zip Code:57741-1003
Mailing Address - Country:US
Mailing Address - Phone:251-232-4750
Mailing Address - Fax:
Practice Address - Street 1:113 COMANCHE RD
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:SD
Practice Address - Zip Code:57741-1002
Practice Address - Country:US
Practice Address - Phone:605-347-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD148478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered