Provider Demographics
NPI:1578777579
Name:ROBERT M. KOMORN, M.D.,F.A.C.S.
Entity Type:Organization
Organization Name:ROBERT M. KOMORN, M.D.,F.A.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:KOMORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-795-5100
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:1726
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:1726
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-795-5100
Practice Address - Fax:713-797-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7430207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000BT831Medicaid
TXP000BT831Medicaid
TX00BT83Medicare ID - Type UnspecifiedPROVIDER NUMBER