Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35-07-8418 | OH |
NPI | 1063407765 |
---|---|
Provider Name | Bruce Rodney Comisar JR. |
First Address | Westerville, OH 43081-1397 |
Second Address | Westerville, OH 43081-1397 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2195977 | (05) | OH |
H11694 | (02) | OH |