MEDICARE: DAVID B HOMER

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	207Q00000X	Family Medicine Physician	25645	CO

General Provider Information

NPI Number	:	1679576938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID B HOMER

Provider Business Mailing Address
First Line	:	PO BOX 2397
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-2397
Country	:	US
Telephone Number	:	970-728-6654
Fax Number	:	970-728-5412

Provider Business Practice Location Address
First Line	:	135 WEST COLORADO AVE
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435
Country	:	US
Telephone Number	:	970-728-6654
Fax Number	:	970-728-5412

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID HOMER
Credential	:	MD
Telephone Number	:	970-728-6654

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/08/2009

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