Provider Demographics
NPI:1093449126
Name:COMER, ROMAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:COMER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ROMAN
Other - Middle Name:
Other - Last Name:COMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:105 SMALL OAK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-8646
Mailing Address - Country:US
Mailing Address - Phone:731-803-0900
Mailing Address - Fax:
Practice Address - Street 1:3340 PLAYERS CLUB PKWY STE 350
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8949
Practice Address - Country:US
Practice Address - Phone:901-844-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN214631163WC0200X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine