Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME80017 | FL |
NPI | 1124025267 |
---|---|
Provider Name | Dr. J. David Holcomb |
First Address | Bradenton, FL 34202-2232 |
Second Address | Sarasota, FL 34237-6045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 19/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F62615 | (02) | |
ME80017 | FLORIDA MEDICAL LICENSE (01) | FL |