Provider Demographics
NPI:1992457196
Name:EWAN, ORANE OMAR
Entity type:Individual
Prefix:
First Name:ORANE
Middle Name:OMAR
Last Name:EWAN
Suffix:
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 1:419 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1457
Mailing Address - Country:US
Mailing Address - Phone:813-500-8302
Mailing Address - Fax:
Practice Address - Street 1:419 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1457
Practice Address - Country:US
Practice Address - Phone:813-500-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159082-1335242T00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist