Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 22341 | SC |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 22341 | SC |
N | 207RI0011X | Interventional Cardiology | 22341 | SC |
N | 207RS0012X | Sleep Medicine | 22341 | SC |
NPI | 1225233497 |
---|---|
Provider Name | Omar Jaraki |
First Address | North Myrtle Beach, SC 29597-0810 |
Second Address | Myrtle Beach, SC 29577-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 22/04/2008 |