Provider Demographics
NPI:1487072245
Name:MOORE, OMAR JISHI (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:JISHI
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3003 CLAIRE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6667
Mailing Address - Country:US
Mailing Address - Phone:904-204-6585
Mailing Address - Fax:850-390-7195
Practice Address - Street 1:3003 CLAIRE LN STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6667
Practice Address - Country:US
Practice Address - Phone:904-204-6585
Practice Address - Fax:850-390-7195
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2024-08-01
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Provider Licenses
StateLicense IDTaxonomies
MIEMC00019932084N0400X
MO20230178512084N0400X
MS302352084N0400X
NC2021-017522084N0400X
TXT90172084N0400X
GA922552084N0400X
IL0361465392084N0400X
LA3309002084N0400X
IN01090166A2084N0400X
AL442972084N0400X
IAMD-499332084N0400X
KS04-461922084N0400X
KYC07332084N0400X
FLME134262084N0600X
FLME1347262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology