Individual
MR. OMAR DAMASO VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4545 BISSONNET #110, BELLAIRE, TX 77401
(713) 751-0633
(713) 751-0605
Mailing address
4545 BISSONNET #110, BELLAIRE, TX 77401
(713) 751-0633
(713) 751-0605
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
K8553
TX
208VP0000X
Pain Medicine Physician
K8553
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
K8553
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004CG
MEDICARE PPMC GROUP #
TX
01
—
0046CC
MEDICARE RPK GROUP #
TX
01
—
00747Y
BEAUMONT MEDICARE GROUP
TX
05
—
079696301
—
TX
01
—
100841906
MEDICAID BEAUMONT
TX
01
—
80180Y
BCBS
—
01
—
85491G
BC/BS BEAUMONT
TX
01
—
8E0572
MEDICARE BEAUMONT
TX
05
—
P080565G5
—
TX
01
—
P081292GU
PAIN MANAGEMENT MEDICARE
TX
Enumeration date
07/21/2006
Last updated
05/21/2024
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