Provider Demographics
NPI:1578640116
Name:COMER, CAROLYN R (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:COMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16821 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-0499
Mailing Address - Country:US
Mailing Address - Phone:360-567-1773
Mailing Address - Fax:360-567-1967
Practice Address - Street 1:16821 SE MCGILLIVRAY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-0499
Practice Address - Country:US
Practice Address - Phone:360-567-1773
Practice Address - Fax:360-567-1967
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039392207K00000X
ORMD23048207K00000X
ALMD9722207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8495798Medicaid
E89651Medicare UPIN
WAGAB33653Medicare PIN