Provider Demographics
NPI:1770296972
Name:COMER, JEROME THOMAS
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:THOMAS
Last Name:COMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 13TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2331
Mailing Address - Country:US
Mailing Address - Phone:304-881-7062
Mailing Address - Fax:
Practice Address - Street 1:1236 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2207
Practice Address - Country:US
Practice Address - Phone:681-204-5400
Practice Address - Fax:681-378-6108
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22-9179175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist