Provider Demographics
NPI:1003072216
Name:HOMEWOOD, VIRGINIA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JEAN
Last Name:HOMEWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 S 4155 W
Mailing Address - Street 2:STE 301
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2000
Mailing Address - Country:US
Mailing Address - Phone:801-964-3865
Mailing Address - Fax:801-964-3894
Practice Address - Street 1:3336 S 4155 W
Practice Address - Street 2:STE 301
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2000
Practice Address - Country:US
Practice Address - Phone:801-964-3865
Practice Address - Fax:801-964-3894
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61215011207V00000X
UT7960145-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology