Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00015691 | WA |
NPI | 1053313411 |
---|---|
Provider Name | James Michael Komorous |
First Address | Gig Harbor, WA 98335-1706 |
Second Address | Gig Harbor, WA 98335-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 16/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1001218 | (05) | WA |
A08478 | (02) |