Provider Demographics
NPI:1346243482
Name:HOLCOMB, RANDALL L (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:HOLCOMB
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:PO BOX 8888
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8888
Mailing Address - Country:US
Mailing Address - Phone:901-259-4260
Mailing Address - Fax:901-259-2785
Practice Address - Street 1:6286 BRIARCREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-259-1600
Practice Address - Fax:901-259-2785
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12265207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS620819926OtherBCBS
TN3371161Medicaid
TN620819926OtherAETNA
TN72209OtherBCBS
MS14670Medicaid
TN200022154OtherRAILROAD MEDICARE
TN2614528OtherCIGNA
TN620819926OtherTRICARE
TN3004063Medicaid
MS7187860Medicaid
AR107443001Medicaid
AR110318002Medicaid
TN4025293OtherAETNA
TN620819926OtherCIGNA
AR110318002Medicaid
TNA96900Medicare UPIN
MS14670Medicaid