Healthcare Provider Details

I. General information

NPI: 1124516158
Provider Name (Legal Business Name): JASON ERWIN OBERMANN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 3RD ST
MONETT MO
65708-2008
US

IV. Provider business mailing address

411 3RD ST
MONETT MO
65708-2008
US

V. Phone/Fax

Practice location:
  • Phone: 417-235-6610
  • Fax:
Mailing address:
  • Phone: 417-235-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number94-09629
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2022010977
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: