Provider Demographics
NPI:1568468122
Name:FIGUEROA, OMAR E (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:E
Last Name:FIGUEROA
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 1:3 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 724
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4757
Mailing Address - Country:US
Mailing Address - Phone:904-308-7959
Mailing Address - Fax:904-308-7938
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 724
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4757
Practice Address - Country:US
Practice Address - Phone:904-308-7959
Practice Address - Fax:904-308-7938
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266639100Medicaid
FL266639100Medicaid
FL62968ZMedicare ID - Type Unspecified