Provider Demographics
NPI:1033108626
Name:KOMRO, DANIEL JOSEPH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:KOMRO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:6453 CHATTERER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2820
Mailing Address - Country:US
Mailing Address - Phone:702-839-0166
Mailing Address - Fax:702-653-3622
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-3971
Practice Address - Fax:702-653-3622
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical