Healthcare Provider Details

I. General information

NPI: 1699651711
Provider Name (Legal Business Name): CAMERON JAMES KOMISAR ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NW FLANDERS ST
PORTLAND OR
97210-3442
US

IV. Provider business mailing address

19626 PERCH CT
LAKE OSWEGO OR
97034-8408
US

V. Phone/Fax

Practice location:
  • Phone: 503-701-8766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: