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General NPI Number Information
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NPI Number | 1063832889
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Entity Type | Individual
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Provider Name | OMAR WAHEED D.O
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Gender | Male
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Dates
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Enumeration Date | 04/19/2014
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 300 EL CAMINO REAL
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2812
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Country | US
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Telephone | 520-803-2926
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 MARYLAND WAY STE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-5339
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Country | US
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Telephone | 615-371-4423
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 007282
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License Number State | AZ
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