Provider Demographics
NPI:1639565294
Name:OMAR, NIDAL BASSAM
Entity Type:Individual
Prefix:
First Name:NIDAL
Middle Name:BASSAM
Last Name:OMAR
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 1:3 MOBILE INFIRMARY CIR STE 410
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3512
Mailing Address - Country:US
Mailing Address - Phone:251-435-6850
Mailing Address - Fax:251-435-6859
Practice Address - Street 1:3 MOBILE INFIRMARY CIR STE 410
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3512
Practice Address - Country:US
Practice Address - Phone:251-232-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.36032207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program