Provider Demographics
NPI:1912254145
Name:SINGH, OMESH SANKAR (DO)
Entity Type:Individual
Prefix:DR
First Name:OMESH
Middle Name:SANKAR
Last Name:SINGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:682-207-1030
Practice Address - Street 1:265 SE JOHN JONES DR STE 102
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8356
Practice Address - Country:US
Practice Address - Phone:817-725-7880
Practice Address - Fax:817-725-7885
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567310207R00000X
TXP9962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346831601Medicaid
TX417581YSE6Medicare PIN