Healthcare Provider Details

I. General information

NPI: 1508101189
Provider Name (Legal Business Name): GILBERT K. COMISSIONG, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS SUITE 302
ST THOMAS VI
00802-2615
US

IV. Provider business mailing address

PO BOX 9401
ST THOMAS VI
00801-2401
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-8599
  • Fax:
Mailing address:
  • Phone: 340-777-8599
  • Fax: 340-777-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1230
License Number StateVI

VIII. Authorized Official

Name: DR. GILBERT KEITH COMISSIONG JR.
Title or Position: MEMBER
Credential: MD
Phone: 340-777-8599