# HOMEWOOD FAMILY MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144206541
- **Authorized official:** RUSSELL JAY HOMEWOOD DO (OWNER)
- **Authorized official phone:** (480) 558-4700

## Contact information

- **Practice address:** 4540 E BASELINE RD, \#113, MESA, AZ 85206-4613
- **Practice address phone:** (480) 558-4700
- **Practice address fax:** (480) 558-1936
- **Mailing address:** PO BOX 1927, GILBERT, AZ 85299-1927
- **Mailing address phone:** (480) 558-4700
- **Mailing address fax:** (480) 558-1936

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3268 | AZ | Yes |

## Other

- **Enumeration date:** 12/16/2005
- **Last updated:** 10/18/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 423997 | — | AZ |