Healthcare Provider Details

I. General information

NPI: 1053313411
Provider Name (Legal Business Name): JAMES MICHAEL KOMOROUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 POINT FOSDICK DR NW STE 219
GIG HARBOR WA
98335-1706
US

IV. Provider business mailing address

4700 POINT FOSDICK DR NW STE 219
GIG HARBOR WA
98335-1706
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-7733
  • Fax: 253-851-8060
Mailing address:
  • Phone: 253-851-7733
  • Fax: 253-851-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number00015691
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00015691
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: