Provider Demographics
NPI:1821062605
Name:OMER, JEFFREY T (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:OMER
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 1:9517 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9237
Mailing Address - Country:US
Mailing Address - Phone:502-587-0521
Mailing Address - Fax:502-587-3886
Practice Address - Street 1:9517 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9237
Practice Address - Country:US
Practice Address - Phone:502-587-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328909Medicaid
KY1821062605OtherNPI
KY0782Medicare PIN
KY110182197Medicare PIN
KY64328909Medicaid
KY0958Medicare PIN
KYCA5672Medicare PIN