National Provider Identifier
Omar Dwayne Jack, DO, PA-C
Omar Dwayne Jack, DO, PA-C is listed in the NPPES registry with a primary specialty of Student in an Organized Health Care Education/Training Program in Buffalo, NY and a listed phone number of (716) 829-6108.
Profile Overview
- NPI
- 1144662909
- Provider Type
- Individual
- Primary Specialty
- Student in an Organized Health Care Education/Training Program
- Enumeration Date
- July 22, 2013
- Last Updated
- March 26, 2024
Practice Location
- 77 Goodell St Ste 550
- Buffalo, NY 14203-1258
Phone: (716) 829-6108
Specialties
- Student in an Organized Health Care Education/Training Program (390200000X)
- Medical Physician Assistant (363AM0700X)
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1144662909
- Entity Type
- Individual
- Last Name
- Jack
- First Name
- Omar
- Middle Name
- Dwayne
- Credential
- DO, PA-C
- Mailing Street Address
- 77 Goodell St Ste 550
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14203-1258
- Mailing Country
- US
- Mailing Phone
- (716) 829-6108
- Practice Street Address
- 77 Goodell St Ste 550
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14203-1258
- Practice Country
- US
- Practice Phone
- (716) 829-6108
- Enumeration Date
- July 22, 2013
- Last Updated
- March 26, 2024
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- March 26, 2024
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Student in an Organized Health Care Education/Training Program (390200000X), Medical Physician Assistant (363AM0700X), Physician Assistant (363A00000X)