Provider Demographics
NPI:1730138561
Name:HOLCOMBE, TRAVIS C (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:C
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 1:300 W CLARENDON AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-266-9066
Mailing Address - Fax:
Practice Address - Street 1:300 W CLARENDON AVE STE 440
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-266-9066
Practice Address - Fax:602-926-1430
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ211292086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ133182-003Medicaid
AZZMD21129Medicare PIN
AZD49698Medicare UPIN