Provider Demographics
NPI:1851358683
Name:HOMER, GREGORY D (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:HOMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2201 N CENTRAL EXPY
Mailing Address - Street 2:STE 185
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2754
Mailing Address - Country:US
Mailing Address - Phone:303-933-8270
Mailing Address - Fax:972-437-3369
Practice Address - Street 1:4605 TOUR 18 DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-6449
Practice Address - Country:US
Practice Address - Phone:303-933-8270
Practice Address - Fax:972-437-3369
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ85842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152869701Medicaid
H66274Medicare UPIN
TX8220B8Medicare PIN
TX300132689Medicare PIN