MEDICARE: MR. ROMAN DAVID COMER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	7344	NC
2	367500000X	Certified Registered Nurse Anesthetist	0024196051	VA
3	367500000X	Certified Registered Nurse Anesthetist	214631	TN
4	367500000X	Certified Registered Nurse Anesthetist	901802	MS

General Provider Information

NPI Number	:	1093449126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROMAN DAVID COMER CRNA

Provider Business Mailing Address
First Line	:	105 SMALL OAK DR
Second Line	:
City	:	HUMBOLDT
State	:	TN
Zip	:	38343-8646
Country	:	US
Telephone Number	:	731-803-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 PLAYERS CLUB PKWY STE 350
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8949
Country	:	US
Telephone Number	:	901-844-1590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	06/29/2026

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