Healthcare Provider Details

I. General information

NPI: 1326580804
Provider Name (Legal Business Name): FAHAD OMAR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5539 N MESA ST
EL PASO TX
79912-5422
US

IV. Provider business mailing address

1512 N ZARAGOZA RD STE B
EL PASO TX
79936-8903
US

V. Phone/Fax

Practice location:
  • Phone: 915-213-0900
  • Fax: 915-271-4145
Mailing address:
  • Phone: 915-213-0900
  • Fax: 915-271-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberR0293
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR0293
License Number StateTX

VIII. Authorized Official

Name: FAHAD OMAR
Title or Position: OWNER/ PHYSICIAN
Credential: M.D.
Phone: 915-213-0900