MEDICARE: DR. ALBERT O OBIOZO MD

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	208000000X	Pediatrics Physician	E7665	AR

General Provider Information

NPI Number	:	1932476132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT O OBIOZO MD

Provider Business Mailing Address
First Line	:	615 THOMPSON AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4557
Country	:	US
Telephone Number	:	870-444-5147
Fax Number	:	870-444-5129

Provider Business Practice Location Address
First Line	:	615 THOMPSON AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4557
Country	:	US
Telephone Number	:	870-444-5147
Fax Number	:	870-444-5129

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

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	03/15/2021

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