MEDICARE: JAMES MICHAEL KOMOROUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician	00015691	WA
2	207N00000X	Dermatology Physician	MD00015691	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053313411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MICHAEL KOMOROUS MD

Provider Business Mailing Address
First Line	:	4700 POINT FOSDICK DR NW STE 219
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-851-7733
Fax Number	:	253-851-7726

Provider Business Practice Location Address
First Line	:	4700 POINT FOSDICK DR NW STE 219
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-851-7733
Fax Number	:	253-851-8060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/15/2024

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