Provider Demographics
NPI:1861458663
Name:DAJANI, OMAR F (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:F
Last Name:DAJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 ST. VINCENT'S WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8431
Mailing Address - Country:US
Mailing Address - Phone:904-276-5100
Mailing Address - Fax:904-276-5393
Practice Address - Street 1:1658 ST. VINCENT'S WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8431
Practice Address - Country:US
Practice Address - Phone:904-276-5100
Practice Address - Fax:904-276-5393
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49977174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064339400Medicaid
FL064339400Medicaid
FLD50688Medicare UPIN