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General NPI Number Information
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NPI Number | 1104389469
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Entity Type | Individual
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Provider Name | OMER ISMAEEL MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2140 KINGSLEY AVE STE 1
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City | ORANGE PARK
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State | FL
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Zip | 32073-5129
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Country | US
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Telephone | 904-368-6809
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 LAKEHORE DR NORTH
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City | FLEMING ISLAND
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State | FL
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Zip | 32003
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Country | US
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Telephone | 904-993-4272
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME162466
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME162466
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License Number State | FL
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