Basic Information
| Provider Information | |||||||||
| NPI: | 1770991754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QAZI | ||||||||
| FirstName: | OMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 CLUB MANOR DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | MAUMELLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721137401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018517402 | ||||||||
| FaxNumber: | 5018514753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 SCHNEIDER DR | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721044811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013321000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30635 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | E-10760 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.