Healthcare Provider Details

I. General information

NPI: 1154524502
Provider Name (Legal Business Name): WILSON S. COMER, JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 WASHINGTON ST
RALEIGH NC
27605-1255
US

IV. Provider business mailing address

867 WASHINGTON ST
RALEIGH NC
27605-1255
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-5867
  • Fax: 919-833-5859
Mailing address:
  • Phone: 919-833-5867
  • Fax: 919-833-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21761
License Number StateNC

VIII. Authorized Official

Name: DR. WILSON SIDNEY COMER JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-833-5867