Healthcare Provider Details

I. General information

NPI: 1982999512
Provider Name (Legal Business Name): DR. OMAR ARIF GAFUR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

515 E 22ND ST APT 5524
INDIANAPOLIS IN
46202-2052
US

V. Phone/Fax

Practice location:
  • Phone: 512-689-1963
  • Fax:
Mailing address:
  • Phone: 512-689-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01096835A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10039716
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2018-02735
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number261750
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number75102
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: