Provider Demographics
NPI:1457447013
Name:HOMAN, THOMAS WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:HOMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2093
Mailing Address - Country:US
Mailing Address - Phone:402-721-0773
Mailing Address - Fax:402-727-6047
Practice Address - Street 1:220 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2093
Practice Address - Country:US
Practice Address - Phone:402-727-5500
Practice Address - Fax:402-727-6047
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant