Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A70413 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A70413 | CA |
NPI | 1336198449 |
---|---|
Provider Name | Mark R Homicz |
First Address | Santa Rosa, CA 95403-3634 |
Second Address | Santa Rosa, CA 95404-3661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 07/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A704130 | BLUE SHIELD OF CALIFORNIA (01) | CA |
I14720 | (02) | |
P00933198 | RAILROAD MEDICARE (01) | CA |