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NPI Code Detail

MEDICARE: DR. DAVID CARTER HOLCOMB PHD

MEDICARE: DR. DAVID CARTER HOLCOMB PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1056NM
2103TC0700XClinical PsychologistPY0765NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790783868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID CARTER HOLCOMB PHD
Provider Business Mailing Address
First Line : PO BOX 245
Second Line :
City : SAN MIGUEL
State : NM
Zip : 88058-0245
Country : US
Telephone Number : 575-522-5466
Fax Number : 575-521-8611
Provider Business Practice Location Address
First Line : 255 W HADLEY AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-1806
Country : US
Telephone Number : 575-268-2634
Fax Number : 866-611-2571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 11/02/2017

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