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NPI Code Detail

MEDICARE: DR. JEFFREY BRIAN COMITALO M.D.

MEDICARE: DR. JEFFREY BRIAN COMITALO M.D.
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
1208600000XSurgery PhysicianME74536FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679567697
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY BRIAN COMITALO M.D.
Provider Business Mailing Address
First Line : 8333 N DAVIS HWY
Second Line : 5TH FLOOR
City : PENSACOLA
State : FL
Zip : 32514-6050
Country : US
Telephone Number : 850-474-8342
Fax Number : 850-969-2886
Provider Business Practice Location Address
First Line : 8333 N DAVIS HWY
Second Line : 5TH FLOOR
City : PENSACOLA
State : FL
Zip : 32514-6050
Country : US
Telephone Number : 850-474-8342
Fax Number : 850-969-2886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 08/31/2016

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