Provider Demographics
NPI:1871648857
Name:HOLSOMBACK, THOMAS NEWTON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NEWTON
Last Name:HOLSOMBACK
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 1:800 DANUBINA
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-5768
Mailing Address - Country:US
Mailing Address - Phone:281-422-5282
Mailing Address - Fax:
Practice Address - Street 1:800 DANUBINA
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-5768
Practice Address - Country:US
Practice Address - Phone:281-422-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5614208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000J0267Medicaid
B23567Medicare UPIN
TXP000J0267Medicaid