Individual
MR. OMAR CORDELL GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8130 LAKEWOOD MAIN ST STE 103, LAKEWOOD RANCH, FL 34202-5068
(954) 551-7041
(941) 487-0474
Mailing address
8130 LAKEWOOD MAIN ST STE 103, LAKEWOOD RANCH, FL 34202-5068
(954) 551-7041
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9107410
FL
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
08/20/2013
Last updated
02/10/2025
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