Provider Demographics
NPI:1528060902
Name:JAMES M KOMOROUS MD PS
Entity type:Organization
Organization Name:JAMES M KOMOROUS MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOMOROUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-752-7705
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:STE B-2003
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-752-7705
Mailing Address - Fax:253-752-0113
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:STE B-2003
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-752-7705
Practice Address - Fax:253-752-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8800574Medicare ID - Type Unspecified