Organization
J R HOLCOMB MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAIRE CLARK (CREDENTIALING)
(210) 614-2100
Entity
Organization
Contact information
Practice address
4410 MEDICAL DR STE 360, SAN ANTONIO, TX 78229-3749
(210) 614-2100
(210) 692-1999
Mailing address
4410 MEDICAL DR STE 360, SAN ANTONIO, TX 78229-3749
(210) 614-2100
(210) 692-1999
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
E4159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0054RF
BLUE CROSS
TX
05
—
201540601
—
TX
01
—
DN3722
RAILROAD MEDICARE
TX
Enumeration date
10/30/2007
Last updated
07/25/2019
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