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NPI Code Detail

MEDICARE: NAYOMI ELLEN OMURA MD

MEDICARE: NAYOMI ELLEN OMURA MD
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
1207ND0101XMOHS-Micrographic Surgery PhysicianME85895FL
2207NS0135XProcedural Dermatology PhysicianME85895FL
3207N00000XDermatology PhysicianME85895FL

General Provider Information

NPI Number : 1710936612
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAYOMI ELLEN OMURA MD
Provider Business Mailing Address
First Line : 600 VILLAGE SQUARE XING
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33410-4542
Country : US
Telephone Number : 561-694-9493
Fax Number :
Provider Business Practice Location Address
First Line : 2601 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34994-4622
Country : US
Telephone Number : 772-219-2777
Fax Number : 772-219-0017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 01/05/2021

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