Provider Demographics
NPI:1558987073
Name:OMAR M JEROUDI, M.D. P.A.
Entity Type:Organization
Organization Name:OMAR M JEROUDI, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:JEROUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-489-1582
Mailing Address - Street 1:PO BOX 272506
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-2506
Mailing Address - Country:US
Mailing Address - Phone:281-724-9940
Mailing Address - Fax:832-632-1979
Practice Address - Street 1:17490 HIGHWAY 3
Practice Address - Street 2:STE A300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3602
Practice Address - Country:US
Practice Address - Phone:281-724-9940
Practice Address - Fax:832-632-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty