Individual provider · Type 1 NPI

Omar Dwayne Jack, DO, PA-C

Student in an Organized Health Care Education/Training Program · Buffalo, NY

NPI number 1144662909 Active

Practice location

77 Goodell St Ste 550
Buffalo, NY 14203-1258

Call (716) 829-6108 Map

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000X1109724 (GA)
Medical Physician Assistant 363AM0700XMA062538 (PA)
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1144662909

Omar Dwayne Jack, DO, PA-C's National Provider Identifier is 1144662909, issued on Jul 22, 2013. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Buffalo, NY. The record was last updated on Mar 26, 2024.