Provider Demographics
NPI:1598734238
Name:OMAR F SELOD DO PA
Entity Type:Organization
Organization Name:OMAR F SELOD DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:SELOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-336-7188
Mailing Address - Street 1:P O BOX 678615
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8615
Mailing Address - Country:US
Mailing Address - Phone:817-336-7188
Mailing Address - Fax:817-335-9039
Practice Address - Street 1:5632 EDWARDS RANCH RD STE 100
Practice Address - Street 2:STE 506
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-336-7188
Practice Address - Fax:817-335-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00154QOtherBCBS
TX145433201Medicaid
TX00154QOtherBCBS
TX145433201Medicaid
TX00154QMedicare PIN
TX0A0059Medicare PIN