Healthcare Provider Details

I. General information

NPI: 1588725881
Provider Name (Legal Business Name): OSASERE LAMBERT AGHEDO D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 DALLAS AVE
SELMA AL
36701-5452
US

IV. Provider business mailing address

731 DALLAS AVE
SELMA AL
36701-5452
US

V. Phone/Fax

Practice location:
  • Phone: 334-872-4778
  • Fax: 334-872-8646
Mailing address:
  • Phone: 334-872-4778
  • Fax: 334-872-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberDO-644
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: