Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 14611 | TX |
Y | 213EG0000X | General Practice | 14611 | TX |
NPI | 1003035189 |
---|---|
Provider Name | Kenneth Max Comer |
First Address | Amarillo, TX 79106-5800 |
Second Address | Amarillo, TX 79106-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |