Healthcare Provider Details

I. General information

NPI: 1962696856
Provider Name (Legal Business Name): ROBERT OMWOYO OMURIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E CAMELBACK RD 1100
PHOENIX AZ
85016-4219
US

IV. Provider business mailing address

PO BOX 708850
SANDY UT
84070-8850
US

V. Phone/Fax

Practice location:
  • Phone: 602-778-3600
  • Fax: 801-352-9502
Mailing address:
  • Phone: 866-869-2395
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101251839
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37284
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101251839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: