Healthcare Provider Details

I. General information

NPI: 1992457196
Provider Name (Legal Business Name): ORANE OMAR EWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 JOSEPHINE ST
DALLAS TX
75246-1457
US

IV. Provider business mailing address

419 JOSEPHINE ST
DALLAS TX
75246-1457
US

V. Phone/Fax

Practice location:
  • Phone: 813-500-8302
  • Fax:
Mailing address:
  • Phone: 813-500-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number159082-1335
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: