Individual
MR. OMAR JAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4351 E LOHMAN AVE STE 301, LAS CRUCES, NM 88011-8262
(575) 532-9755
(575) 532-8881
Mailing address
4351 E. LOHMAN AVENUE, SUITE 301, LAS CRUCES, NM 88011
(575) 532-9755
(575) 532-8881
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1889
WI
363A00000X
Physician Assistant
Primary
PA2005-0019
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376696971
—
WI
05
—
588571
—
NM
Enumeration date
01/19/2007
Last updated
11/15/2023
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