Provider Demographics
NPI:1376582395
Name:ROBERT M HOMER MD PA
Entity Type:Organization
Organization Name:ROBERT M HOMER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-3557
Mailing Address - Street 1:7050 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 15-195
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:561-392-3557
Mailing Address - Fax:561-392-3587
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-392-3557
Practice Address - Fax:561-392-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty