Provider Demographics
NPI:1154494805
Name:ADAMS, OMAR J (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:J
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SHADY BRANCH TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4930
Mailing Address - Country:US
Mailing Address - Phone:386-672-9667
Mailing Address - Fax:386-673-6364
Practice Address - Street 1:103 SHADY BRANCH TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4930
Practice Address - Country:US
Practice Address - Phone:386-672-9667
Practice Address - Fax:386-673-6364
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043572207P00000X
NC28613207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2011-0670OtherSTATE MEDICAL LICENSE
FLME43572OtherSTATE MEDICAL LICENSE
FL041884600Medicaid
NMMD2011-0670OtherSTATE MEDICAL LICENSE
FLD62005Medicare UPIN
FLD62005Medicare UPIN