Provider Demographics
NPI:1073540977
Name:DEMENT, OMAN E (MD)
Entity Type:Individual
Prefix:
First Name:OMAN
Middle Name:E
Last Name:DEMENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1532 W 32ND ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1607
Mailing Address - Country:US
Mailing Address - Phone:417-347-7009
Mailing Address - Fax:417-347-3288
Practice Address - Street 1:1532 W 32ND ST
Practice Address - Street 2:STE 401
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1607
Practice Address - Country:US
Practice Address - Phone:417-347-7009
Practice Address - Fax:417-347-3288
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO34577207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010054250OtherRR MEDICARE
KS100142750BMedicaid
MO200882330Medicaid
MO6076OtherANTHEM
OK100177670AMedicaid
MO6076OtherANTHEM
OK100177670AMedicaid