Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Omar Dwayne Jack, DO, PA-C

Individual provider Physician Assistant · NPI 1144662909

Omar Dwayne Jack, DO, PA-C is a Physician Assistant in Buffalo, New York. Licensed in Georgia and Pennsylvania. Registered with an NPI since 2013.

Licensed in
GA, PA
In the registry since
2013
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

77 Goodell St Ste 550
Buffalo, NY 14203-1258
Phone: (716) 829-6108
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X
Physician Assistant Taxonomy 363A00000X · Licence 1109724 (GA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence MA062538 (PA)

Record details

NPI number1144662909
Entity typeIndividual (Type 1)
GenderMale
Credentials DO , PA-C
Sole proprietorNo
NPI enumeratedJuly 22, 2013
Last updated in NPPESMarch 26, 2024
Certification dateMarch 26, 2024
Mailing address77 Goodell St Ste 550, Buffalo, NY 14203-1258

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