Provider Demographics
NPI:1508157785
Name:JAMAL, OMER MOHAMMED
Entity Type:Individual
Prefix:
First Name:OMER
Middle Name:MOHAMMED
Last Name:JAMAL
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 1:350 N ERVAY ST
Mailing Address - Street 2:2509
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3830
Mailing Address - Country:US
Mailing Address - Phone:469-358-9484
Mailing Address - Fax:
Practice Address - Street 1:350 N ERVAY ST
Practice Address - Street 2:2509
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3830
Practice Address - Country:US
Practice Address - Phone:469-358-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9597207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine