Healthcare Provider Details

I. General information

NPI: 1396679965
Provider Name (Legal Business Name): OMAR AL KOMI M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 CAPITAL MEDICAL BLVD SUITE 200-A, CAPITAL PRIMARY
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

2626 CARE DRIVE SUITE 102
TALLAHASSEE FL
32308
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-8235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: