Provider Demographics
NPI:1730246471
Name:COMITER P.A.
Entity type:Organization
Organization Name:COMITER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:COMITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-943-0895
Mailing Address - Street 1:1 W SAMPLE RD
Mailing Address - Street 2:# 305
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3547
Mailing Address - Country:US
Mailing Address - Phone:954-943-0895
Mailing Address - Fax:
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:# 305
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-943-0895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 12864208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040941300Medicaid
FL1437224318OtherNPI INDIVIDUAL
FL040941300Medicaid
FL06619ZMedicare ID - Type Unspecified