Provider Demographics
NPI:1013019793
Name:COMLY, WILLIAM MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:COMLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 WILLETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072
Mailing Address - Country:US
Mailing Address - Phone:307-745-8999
Mailing Address - Fax:307-745-4150
Practice Address - Street 1:3116 WILLETT DRIVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-745-8999
Practice Address - Fax:307-745-4150
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3486A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110006099OtherRAILROAD MEDICARE
WY100196500Medicaid
WY302206OtherBCBS
WY110006099OtherRAILROAD MEDICARE
WYA73009Medicare UPIN