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General NPI Number Information
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NPI Number | 1013276237
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Entity Type | Individual
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Provider Name | MAURA JANE HOLCOMB M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 1618 S MILLENIUM WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-6457
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Country | US
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Telephone | 208-884-3376
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Fax | 208-884-0858
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Provider Business Mailing Address
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Address Line | 1618 S MILLENIUM WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-6457
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Country | US
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Telephone | 208-884-3376
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Fax | 208-884-0858
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 70591
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BP10044142
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M16146
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License Number State | ID
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