MEDICARE: DAVID W OBERKROM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	100576	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	23141020	OTHER	MP	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1043217938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W OBERKROM M.D.

Provider Business Mailing Address
First Line	:	512 W MAIN ST
Second Line	:	P O BOX 158
City	:	COLE CAMP
State	:	MO
Zip	:	65325-0158
Country	:	US
Telephone Number	:	660-668-0851
Fax Number	:	660-668-3041

Provider Business Practice Location Address
First Line	:	3700 W 10TH ST
Second Line	:	SUITE 100
City	:	SEDALIA
State	:	MO
Zip	:	65301-2540
Country	:	US
Telephone Number	:	660-827-0015
Fax Number	:	660-827-7425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/01/2022

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Directions to “ DAVID W OBERKROM M.D.” Practice Location

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