Provider Demographics
NPI:1821035932
Name:HOMER, PAUL I (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:I
Last Name:HOMER
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 1:4700 NW 2ND AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4878
Mailing Address - Country:US
Mailing Address - Phone:561-544-1666
Mailing Address - Fax:561-544-1665
Practice Address - Street 1:4700 NW 2ND AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4878
Practice Address - Country:US
Practice Address - Phone:561-544-1666
Practice Address - Fax:561-544-1665
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9807OtherGROUP NUMBER
FLD55921Medicare UPIN
FL50960AMedicare ID - Type Unspecified