Individual
DR. OMAR I MASSOUD
Active
Individual
DR. OMAR I MASSOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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