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General NPI Number Information
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NPI Number | 1083635841
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Entity Type | Individual
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Provider Name | OMAR DAMASO VIDAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 4545 BISSONNET #110
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City | BELLAIRE
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State | TX
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Zip | 77401
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Country | US
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Telephone | 713-751-0633
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Fax | 713-751-0605
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Provider Business Mailing Address
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Address Line | 4545 BISSONNET #110
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City | BELLAIRE
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State | TX
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Zip | 77401
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Country | US
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Telephone | 713-751-0633
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Fax | 713-751-0605
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | K8553
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | K8553
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | K8553
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License Number State | TX
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