Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 70591 | MT |
Y | 207N00000X | Dermatologist | M16146 | ID |
N | 207R00000X | Internist | BP10044142 | TX |
N | 111NI0900X | Internist | BP10044142 | TX |
NPI | 1013276237 |
---|---|
Provider Name | Maura Jane Holcomb |
First Address | Meridian, ID 83642-6457 |
Second Address | Meridian, ID 83642-6457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2012 |
Last Update Date | 03/12/2021 |