Provider Demographics
NPI:1982047676
Name:JEROUDI, OMAR MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:MOHAMED
Last Name:JEROUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 272506
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-2506
Mailing Address - Country:US
Mailing Address - Phone:281-724-9940
Mailing Address - Fax:832-632-1979
Practice Address - Street 1:17490 HIGHWAY 3
Practice Address - Street 2:STE A300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3602
Practice Address - Country:US
Practice Address - Phone:281-724-9940
Practice Address - Fax:832-632-1979
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ4995207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology