1326024183 NPI number — DR. BRIAN ERIC HOMER D.P.M

Table of content: (NPI 1861597320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326024183 NPI number — DR. BRIAN ERIC HOMER D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOMER
Provider First Name:
BRIAN
Provider Middle Name:
ERIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326024183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 W 14 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAWSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48017-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-288-8900
Provider Business Mailing Address Fax Number:
248-288-8989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 W 14 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAWSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48017-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-288-8900
Provider Business Practice Location Address Fax Number:
248-288-8989
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  5901BH001699 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480F318080 . This is a "BLUE CROSS -CLAWSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 48OH2128370 . This is a "ALLEN PARK BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00102057 . This is a "MEDICARE RAILROAD ALLEN PARK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1283450001 . This is a "CLAWSON DME NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F383890 . This is a "BCBS DME CLAWSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4319060001 . This is a "ALLEN PARK DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0H20650 . This is a "BCBS DME ALLEN PART" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480018640 . This is a "MEDICARE RAILROAD CLAWSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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