Provider Demographics
NPI:1306123112
Name:COMER, DAVID P (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
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 1:2600 N LIMESTONE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1114
Mailing Address - Country:US
Mailing Address - Phone:934-523-9850
Mailing Address - Fax:937-523-9859
Practice Address - Street 1:2600 N LIMESTONE ST FL 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-523-9850
Practice Address - Fax:937-523-9859
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001367A363A00000X
OH50003397RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INOPRMedicaid
OH0111099Medicaid
000000676851OtherANTHEM
OH0111099Medicaid
OHH111930Medicare PIN