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General NPI Number Information
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NPI Number | 1023866605
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Entity Type | Individual
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Provider Name | OMER ABDRABBUH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 2311 MEDICAL DISTRICT DR SUPPORT BLDG., A RM 02.240
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City | DALLAS
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State | TX
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Zip | 75235
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Country | US
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Telephone | 608-698-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 112 WELFORD LN
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 314-941-1518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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