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General NPI Number Information
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NPI Number | 1538367057
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Entity Type | Individual
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Provider Name | RUSSELL WESLEY HOMAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1876 EIDER CT STE A
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4537
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Country | US
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Telephone | 850-701-9652
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Fax | 850-312-4158
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Provider Business Mailing Address
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Address Line | 1876 EIDER CT STE A
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4537
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Country | US
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Telephone | 850-701-9652
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Fax | 850-312-4158
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME135682
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License Number State | FL
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