Provider Demographics
NPI:1417442369
Name:YACOB, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:YACOB
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-358-6361
Mailing Address - Fax:501-358-6714
Practice Address - Street 1:625 UNITED DR STE 220
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7835
Practice Address - Country:US
Practice Address - Phone:501-358-6361
Practice Address - Fax:501-358-6714
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-19041207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty