Omar Dwayne Jack, DO, PA-C is a medicare enrolled "Student In An Organized Health Care Education/training Program" in Buffalo, New York. His current practice location is
77 Goodell St Ste 550, Buffalo, New York. You can reach out to his office (for appointments etc.) via phone at
(716) 829-6108.
Omar Dwayne Jack is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1144662909.
Provider's Profile
| Full Name | Omar Dwayne Jack |
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| Gender | Male |
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| Speciality | |
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| Experience | Years |
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| Location | 77 Goodell St Ste 550, Buffalo, New York |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Omar Dwayne Jack attended and graduated from in
NPI Data:
- NPI Number: 1144662909
- Provider Enumeration Date: 07/22/2013
- Last Update Date: 03/26/2024
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
Medical Identifiers
Medical identifiers for Omar Dwayne Jack such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1144662909 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 1109724 (Georgia) | Secondary |
| 363AM0700X | Physician Assistant - Medical | MA062538 (Pennsylvania) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Omar Dwayne Jack is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Omar Dwayne Jack, DO, PA-C
77 Goodell St Ste 550,
Buffalo, NY 14203-1258
Ph: (716) 829-6108 | Omar Dwayne Jack, DO, PA-C
77 Goodell St Ste 550,
Buffalo, NY 14203-1258
Ph: (716) 829-6108 |
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