Healthcare Provider Details

I. General information

NPI: 1275252454
Provider Name (Legal Business Name): OMAR A IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11351 S FRONTAGE RD
YUMA AZ
85367-7862
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-4000
  • Fax: 928-336-3864
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: