Provider Demographics
NPI:1538367057
Name:HOMAN, RUSSELL WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:WESLEY
Last Name:HOMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:RUSTY
Other - Middle Name:WESLEY
Other - Last Name:HOMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1876 EIDER CT STE A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4537
Mailing Address - Country:US
Mailing Address - Phone:850-701-9652
Mailing Address - Fax:850-312-4158
Practice Address - Street 1:1876 EIDER CT STE A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4537
Practice Address - Country:US
Practice Address - Phone:850-701-9652
Practice Address - Fax:850-312-4158
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135682208000000X
NC2013-00982208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics