Individual
DR. OMAR I MASSOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-0001
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
(205) 297-9411
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
46436
WI
207RG0100X
Gastroenterology Physician
Primary
51194
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000011354W
HUMANA
—
01
—
03773767
MISSISSIPPI MEDICAID
AL
01
—
051067823
BLUE CROSS BLUE SHIELD OF AL
AL
01
—
102I103373
MEDICARE
AL
05
—
114043
—
AL
05
—
34468900
—
WI
05
—
ENROLLED
—
MN
Enumeration date
05/15/2006
Last updated
06/07/2010
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