Provider Demographics
NPI:1073508560
Name:HOMOKY, DOUGLAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:HOMOKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-6777
Mailing Address - Fax:423-246-7766
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-246-6777
Practice Address - Fax:423-246-7766
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD031208207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000053389OtherANTHEM
VA005826497Medicaid
WV1802969000Medicaid
TN3700033Medicaid
KY64712292Medicaid
TN7586071OtherAETNA
TN003115442OtherBCBS OF TN
TN100028374OtherPHP TENNCARE
VA208758OtherANTHEM
TNTN0113OtherUNITED HEALTHCARE RIVER V
WV1802969000Medicaid
TN7586071OtherAETNA
TN3835911Medicare ID - Type Unspecified
KY64712292Medicaid