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General NPI Number Information
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NPI Number | 1558987073
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Entity Type | Organization
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Legal Business Name | OMAR M JEROUDI, M.D. P.A.
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Dates
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Enumeration Date | 06/20/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 17490 HIGHWAY 3 STE A300
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City | WEBSTER
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State | TX
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Zip | 77598-3602
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Country | US
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Telephone | 281-724-9940
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Fax | 832-632-1979
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Provider Business Mailing Address
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Address Line | PO BOX 272506
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City | HOUSTON
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State | TX
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Zip | 77277-2506
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Country | US
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Telephone | 281-724-9940
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Fax | 832-632-1979
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMAR MOHAMED JEROUDI
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Credential | MD
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Telephone | 832-489-1582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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