Provider Demographics
NPI:1871896506
Name:JAMES R. HOMAN, D.O., INC.
Entity type:Organization
Organization Name:JAMES R. HOMAN, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-873-8591
Mailing Address - Street 1:4212 S MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1302
Mailing Address - Country:US
Mailing Address - Phone:813-837-8591
Mailing Address - Fax:813-839-6832
Practice Address - Street 1:4212 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1302
Practice Address - Country:US
Practice Address - Phone:813-837-8591
Practice Address - Fax:813-839-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3261261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE32071Medicare UPIN