Provider Demographics
NPI:1134123755
Name:OMRON, EDWARD M (MD, MPH, FCCP)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:OMRON
Suffix:
Gender:M
Credentials:MD, MPH, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18525 SUTTER BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8100
Mailing Address - Country:US
Mailing Address - Phone:408-778-0022
Mailing Address - Fax:408-778-0055
Practice Address - Street 1:18525 SUTTER BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8100
Practice Address - Country:US
Practice Address - Phone:408-778-0022
Practice Address - Fax:408-778-0055
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105179207RP1001X, 207RC0200X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4718594Medicaid
MIN15080007Medicare ID - Type Unspecified