Provider Demographics
NPI:1497877765
Name:MUHAMMAD, OMAR WR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:WR
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 E MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-2246
Mailing Address - Country:US
Mailing Address - Phone:405-488-4793
Mailing Address - Fax:405-602-2528
Practice Address - Street 1:3312 E MAXWELL DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-2246
Practice Address - Country:US
Practice Address - Phone:405-488-4793
Practice Address - Fax:405-602-2528
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service