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General NPI Number Information
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NPI Number | 1346568532
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Entity Type | Organization
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Legal Business Name | OMAR MEDICAL PLLC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 100 WHETSTONE PL STE 204
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5774
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Country | US
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Telephone | 217-720-3144
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WHETSTONE PL STE 204
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5774
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Country | US
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Telephone | 217-720-3144
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALID OMAR
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Credential | M.D.
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Telephone | 217-720-3144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0097900
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0094907
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License Number State | FL
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