Individual
OMAR S QUEENSBOURROW
Active
Individual
OMAR S QUEENSBOURROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006678
GA
363AM0700X
Medical Physician Assistant
PA 9106708
FL
Other
Enumeration date
11/19/2012
Last updated
08/04/2021
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