Basic Information
| Provider Information | |||||||||
| NPI: | 1861648396 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | COMER | ||||||||
| FirstName: | BRETT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROSE ST # C236 | ||||||||
| Address2: | OTOLARYNGOLOGY | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592575097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 740 S LIMESTONE | ||||||||
| Address2: | EAR, NOSE & THROAT CLINIC | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592575405 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 47100 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 7100299680 | 05 | KY | MEDICAID | K153750 | 01 | KY | MEDICARE | OTHER |