Healthcare Provider Details

I. General information

NPI: 1437619939
Provider Name (Legal Business Name): OMER A IDREES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 MAJOR BLVD STE 150
ORLANDO FL
32819-7971
US

IV. Provider business mailing address

2255 GLADES RD STE 228W
BOCA RATON FL
33431-7391
US

V. Phone/Fax

Practice location:
  • Phone: 407-409-8118
  • Fax: 407-961-4290
Mailing address:
  • Phone: 615-320-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME166676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: