Individual
OMAR MUBAIDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
(321) 434-1775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS12067
FL
208M00000X
Hospitalist Physician
Primary
OS12067
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LZ965
MEDICARE
FL
01
—
PENDING
MEDICARE
FL
05
—
PENDING
—
FL
Enumeration date
04/04/2013
Last updated
03/25/2020
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