Provider Demographics
NPI:1669270492
Name:COMER, RICHARD JAMES
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:COMER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31101 N HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-9371
Mailing Address - Country:US
Mailing Address - Phone:707-354-5041
Mailing Address - Fax:
Practice Address - Street 1:31101 N HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-9371
Practice Address - Country:US
Practice Address - Phone:707-354-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7178394172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver