Provider Demographics
NPI:1457447013
Name:HOMAN, THOMAS WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:HOMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1610 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2093
Mailing Address - Country:US
Mailing Address - Phone:402-721-0773
Mailing Address - Fax:402-727-6047
Practice Address - Street 1:20 POWER DR STE 5
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7701
Practice Address - Country:US
Practice Address - Phone:712-309-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE756363A00000X
IA107710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant