=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649369844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BISHR OMARY MD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 MIRANDA AVE PALO ALTO VA MEDICAL CENTER
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-493-5000
-----------------------------------------------------
Fax | 650-852-3259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 485 EMMONS DR
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94043-2726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-493-5000
-----------------------------------------------------
Fax | 650-852-3259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | G058813
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | G058813
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------