Healthcare Provider Details

I. General information

NPI: 1932723012
Provider Name (Legal Business Name): DUSTIN COMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 CARGO RD
ORLANDO FL
32827-4349
US

IV. Provider business mailing address

6505 STATE ROAD 46
MIMS FL
32754-5916
US

V. Phone/Fax

Practice location:
  • Phone: 407-825-2001
  • Fax:
Mailing address:
  • Phone: 321-591-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD525009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: