Provider Demographics
NPI:1891028809
Name:COMER, ERIC THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:COMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8358
Mailing Address - Country:US
Mailing Address - Phone:269-279-5240
Mailing Address - Fax:269-273-9060
Practice Address - Street 1:850 S HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8358
Practice Address - Country:US
Practice Address - Phone:269-279-5240
Practice Address - Fax:269-273-9060
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI363A00000XOtherTAXONOMY
MI5601005571OtherSTATE LICENSE