Provider Demographics
NPI:1962696856
Name:OMURIA, ROBERT OMWOYO (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:OMWOYO
Last Name:OMURIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708850
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:866-869-2395
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:2525 E CAMELBACK RD
Practice Address - Street 2:1100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4219
Practice Address - Country:US
Practice Address - Phone:602-778-3600
Practice Address - Fax:801-352-9502
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251839208M00000X, 207R00000X
AZ37284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00418604OtherRAIL ROAD MEDICARE
AZ300361Medicaid
AZ117722Medicare PIN
AZZ120681Medicare PIN