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Organization
HOMEWOOD FAMILY MEDICINE PLLC
Active
Organization
HOMEWOOD FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL JAY HOMEWOOD DO (OWNER)
(480) 558-4700
Entity
Organization
Contact information
Practice address
4540 E BASELINE RD, #113, MESA, AZ 85206-4613
(480) 558-4700
(480) 558-1936
Mailing address
PO BOX 1927, GILBERT, AZ 85299-1927
(480) 558-4700
(480) 558-1936
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3268
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
423997
—
AZ
Enumeration date
12/16/2005
Last updated
10/18/2007
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