Healthcare Provider Details

I. General information

NPI: 1285779868
Provider Name (Legal Business Name): HOLCOMB PEDIATRICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MENGER SPGS 1240
BOERNE TX
78006-7218
US

IV. Provider business mailing address

134 MENGER SPGS 1240
BOERNE TX
78006-7218
US

V. Phone/Fax

Practice location:
  • Phone: 830-816-5437
  • Fax: 830-331-9438
Mailing address:
  • Phone: 830-816-5437
  • Fax: 830-331-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL6945
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberL6945
License Number StateTX

VIII. Authorized Official

Name: DR. RICHARD ALLEN HOLCOMB
Title or Position: OWNER
Credential: MD
Phone: 210-681-3343