Provider Demographics
NPI:1477523272
Name:HOLCOMB, FREDERICK LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LARRY
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 1:1015 S JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5760
Mailing Address - Country:US
Mailing Address - Phone:256-381-5510
Mailing Address - Fax:256-386-5551
Practice Address - Street 1:1015 S JACKSON HWY
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5760
Practice Address - Country:US
Practice Address - Phone:256-381-5510
Practice Address - Fax:256-386-5551
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000040676Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
AL0000040675Medicare ID - Type UnspecifiedMEDICARE PROVIDER #