=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811008055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIDNEY JAMES COMISSIONG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SUITE 207 VI MEDICAL FOUNDATION
-----------------------------------------------------
City | ST. THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-777-8520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306813
-----------------------------------------------------
City | ST THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00803-6813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-777-8520
-----------------------------------------------------
Fax | 340-779-7256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 923
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------