Healthcare Provider Details

I. General information

NPI: 1134107006
Provider Name (Legal Business Name): BARRY WAYNE HOLCOMB JR. MD,FCCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

IV. Provider business mailing address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

V. Phone/Fax

Practice location:
  • Phone: 970-731-3700
  • Fax: 970-731-0511
Mailing address:
  • Phone: 970-731-3700
  • Fax: 970-731-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35273
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0036438
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: