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General NPI Number Information
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NPI Number | 1558984724
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Entity Type | Individual
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Provider Name | SAMAH ABU OMAR MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2020
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 931 HIGHLAND BLVD STE 3350
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City | BOZEMAN
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State | MT
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Zip | 59715-6914
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Country | US
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Telephone | 406-414-5331
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3098
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Country | US
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Telephone | 503-494-8459
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Fax | 503-494-6990
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MED-PHYS-LIC-147545
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License Number State | MT
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