MEDICARE: DEREK KEITH HOLCOMBE M.D.

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
1	207RG0100X	Gastroenterology Physician	14800	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	100008592	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51028627	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841203833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK KEITH HOLCOMBE M.D.

Provider Business Mailing Address
First Line	:	3368 HIGHWAY 280
Second Line	:	SUITE 214
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3393
Country	:	US
Telephone Number	:	256-329-2829
Fax Number	:	256-329-9135

Provider Business Practice Location Address
First Line	:	3368 HIGHWAY 280 STE 107
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3375
Country	:	US
Telephone Number	:	256-329-2829
Fax Number	:	256-329-9135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	02/01/2023

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