Provider Demographics
NPI:1720062516
Name:KOMAR, ALEKSANDER RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEKSANDER
Middle Name:RICHARD
Last Name:KOMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3165
Mailing Address - Country:US
Mailing Address - Phone:321-435-3650
Mailing Address - Fax:321-435-3652
Practice Address - Street 1:7000 SPYGLASS CT STE 350
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-253-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264924100Medicaid
FL29027OtherBLUE CROSS
FLP00075757OtherRAILROAD MEDICARE
H64755Medicare UPIN
FL29027XMedicare PIN