Healthcare Provider Details

I. General information

NPI: 1356655187
Provider Name (Legal Business Name): OMER MANSOOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 GREENWOOD AVE STE 204
WEST PALM BEACH FL
33407-2452
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 561-558-1212
  • Fax: 561-558-1292
Mailing address:
  • Phone: 305-662-8668
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME 107848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: