Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 17448 | MS |
Y | 207SG0201X | Clinical Genetics (M.D.) | 30159 | NE |
NPI | 1811935323 |
---|---|
Provider Name | Dr. Omar Ali Abdul-Rahman SR. |
First Address | Omaha, NE 68198-4500 |
Second Address | Omaha, NE 68198-6819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 20/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30159 | MEDICAL LICENSE (01) | NE |
I33977 | (02) | MS |