Provider Demographics
NPI:1710956792
Name:HALCOMB, JOHN DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DARRELL
Last Name:HALCOMB
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 1:850 TOWER DR
Mailing Address - Street 2:STE 110
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4238
Mailing Address - Country:US
Mailing Address - Phone:432-582-0700
Mailing Address - Fax:432-582-0703
Practice Address - Street 1:850 TOWER DR
Practice Address - Street 2:STE 110
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4238
Practice Address - Country:US
Practice Address - Phone:432-582-0700
Practice Address - Fax:432-582-0703
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8674207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115364503Medicaid
TX00L14TMedicare ID - Type Unspecified
TX115364503Medicaid