Provider Demographics
NPI:1316455520
Name:MAHMOUD, OMAR M SR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:M
Last Name:MAHMOUD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 S COOPER ST APT 233
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5525
Mailing Address - Country:US
Mailing Address - Phone:682-400-9807
Mailing Address - Fax:
Practice Address - Street 1:2003 S COOPER ST APT 233
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5525
Practice Address - Country:US
Practice Address - Phone:682-400-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)