Healthcare Provider Details

I. General information

NPI: 1477519544
Provider Name (Legal Business Name): HOLCOMB FACIAL PLASTIC SURGERY, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S SCHOOL AVE SUITE 800
SARASOTA FL
34237-6014
US

IV. Provider business mailing address

1 S SCHOOL AVE SUITE 800
SARASOTA FL
34237-6014
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-8679
  • Fax: 941-365-8680
Mailing address:
  • Phone: 941-365-8679
  • Fax: 941-365-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME80017
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN DAVID HOLCOMB
Title or Position: MANAGER
Credential: M.D.
Phone: 941-365-8679