Provider Demographics
NPI:1659377141
Name:HOLCOMBE, KEVIN WESTRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WESTRAY
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5535
Mailing Address - Fax:
Practice Address - Street 1:1400 ROCKLEDGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2846
Practice Address - Country:US
Practice Address - Phone:864-238-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112246207Q00000X, 207P00000X
SC21450207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214501Medicaid
FLNG741OtherMEDICARE HF
SC214501Medicaid
H40782Medicare UPIN