Provider Demographics
NPI:1083906028
Name:OMATSEYE, JIM O JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:O
Last Name:OMATSEYE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:OTI
Other - Last Name:OMATSEYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8057 BLUE SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4448
Mailing Address - Country:US
Mailing Address - Phone:908-906-1010
Mailing Address - Fax:
Practice Address - Street 1:3000 CORAL HILLS DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4108
Practice Address - Country:US
Practice Address - Phone:908-906-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258593207P00000X
FL109386207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine