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General NPI Number Information
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NPI Number | 1003800434
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Entity Type | Organization
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Legal Business Name | JEFFREY C. KOMENDA, M.D., P.A.
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 5944 W PARKER RD SUITE 100
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City | PLANO
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State | TX
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Zip | 75093-6421
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Country | US
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Telephone | 972-608-1868
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Fax | 972-943-8644
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Provider Business Mailing Address
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Address Line | 5944 W PARKER RD
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City | PLANO
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State | TX
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Zip | 75093-6422
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Country | US
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Telephone | 972-608-1868
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Fax | 972-943-8644
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. JEFFREY CRAIG KOMENDA
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Credential | M.D.
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Telephone | 972-608-1868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | H6350
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License Number State | TX
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