Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1497877765 |
---|---|
Provider Name | Omar Wr Muhammad |
First Address | Oklahoma City, OK 73121-2246 |
Second Address | Oklahoma City, OK 73121-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 11/05/2011 |