Provider Demographics
NPI:1386266039
Name:GARDIZI, OMAR (DO)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:GARDIZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1624 N CAMPBELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-694-8888
Mailing Address - Fax:520-626-3941
Practice Address - Street 1:1625 N CAMPBELL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-4330
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-626-3941
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZR33552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology