Provider Demographics
NPI:1164681334
Name:HOMAN, DAVID JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:HOMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:1233 WAYNE GILMORE CIR
Practice Address - Street 2:SUITE 450
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6405
Practice Address - Country:US
Practice Address - Phone:337-942-3006
Practice Address - Fax:337-942-7744
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202873207RC0000X, 207RI0011X
IL036.122064207RC0000X
CAA119413207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941786Medicaid
LA376000YJQDMedicare PIN