Provider Demographics
NPI:1740309624
Name:HOLCOMB, JASON OMAR (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:OMAR
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE L-30
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3211
Mailing Address - Country:US
Mailing Address - Phone:248-865-4238
Mailing Address - Fax:248-865-4237
Practice Address - Street 1:2070 BIDDLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4080
Practice Address - Country:US
Practice Address - Phone:734-225-9100
Practice Address - Fax:734-225-9100
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301080364207X00000X
FLME98195207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H28427OtherBLUE CROSS
1699102244OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H28427OtherBLUE CROSS
FL96132OtherBC/BS
FL4240536OtherAETNA