Provider Demographics
NPI:1477624021
Name:OMEL, JAMES LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LLOYD
Last Name:OMEL
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 1:3115 BRIARWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7224
Mailing Address - Country:US
Mailing Address - Phone:308-381-0289
Mailing Address - Fax:
Practice Address - Street 1:3115 BRIARWOOD BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7224
Practice Address - Country:US
Practice Address - Phone:308-381-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB90780Medicare UPIN