Provider Demographics
NPI:1467631135
Name:J R HOLCOMB MD PA
Entity Type:Organization
Organization Name:J R HOLCOMB MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-2100
Mailing Address - Street 1:4410 MEDICAL DR STE 360
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3749
Mailing Address - Country:US
Mailing Address - Phone:210-614-2100
Mailing Address - Fax:210-692-1999
Practice Address - Street 1:4410 MEDICAL DR STE 360
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3749
Practice Address - Country:US
Practice Address - Phone:210-614-2100
Practice Address - Fax:210-692-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4159207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0054RFOtherBLUE CROSS
TX201540601Medicaid
TXDN3722OtherRAILROAD MEDICARE
TXDN3722OtherRAILROAD MEDICARE
TX201540601Medicaid