Individual
MARK R HOMICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 4TH ST STE 120, SANTA ROSA, CA 95404-3661
(707) 523-7025
(707) 523-3024
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 523-3024
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
A70413
CA
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
A70413
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A704130
BLUE SHIELD OF CALIFORNIA
CA
01
—
P00933198
RAILROAD MEDICARE
CA
Enumeration date
05/08/2006
Last updated
02/07/2012
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