Provider Demographics
NPI:1659541548
Name:HOMER A PASCHALL MD PA
Entity Type:Organization
Organization Name:HOMER A PASCHALL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:PASCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386386-328-1477
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-1007
Mailing Address - Country:US
Mailing Address - Phone:386-328-1476
Mailing Address - Fax:386-328-9604
Practice Address - Street 1:310 S PALM AVE STE 3
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4161
Practice Address - Country:US
Practice Address - Phone:386-328-1476
Practice Address - Fax:386-328-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01770Medicare PIN
FL01770Medicare PIN