MEDICARE: OMAR WR MUHAMMAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1497877765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR WR MUHAMMAD

Provider Business Mailing Address
First Line	:	3312 E MAXWELL DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-2246
Country	:	US
Telephone Number	:	405-488-4793
Fax Number	:	405-602-2528

Provider Business Practice Location Address
First Line	:	3312 E MAXWELL DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-2246
Country	:	US
Telephone Number	:	405-488-4793
Fax Number	:	405-602-2528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	05/11/2011

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Directions to “ OMAR WR MUHAMMAD ” Practice Location

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