Provider Demographics
NPI:1467501353
Name:OMAR, SASPIN NAKORNSRI (MD)
Entity Type:Individual
Prefix:
First Name:SASPIN
Middle Name:NAKORNSRI
Last Name:OMAR
Suffix:
Gender:F
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E OVERTON RD
Practice Address - Street 2:BLUITT-FLOWERS HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5946
Practice Address - Country:US
Practice Address - Phone:214-266-4200
Practice Address - Fax:214-266-4218
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00705548OtherRAILROAD MEDICARE
TX183031702Medicaid
TX8W8854OtherBLUE CROSS BLUE SHIELD
TX183031701Medicaid
TX183031702Medicaid
TX183031701Medicaid