Provider Demographics
NPI:1518586213
Name:SHOEWU, OLUWASEGUN AFOLABI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUWASEGUN
Middle Name:AFOLABI
Last Name:SHOEWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7488
Mailing Address - Country:US
Mailing Address - Phone:417-317-5330
Mailing Address - Fax:417-763-3370
Practice Address - Street 1:5571 N 21ST ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7488
Practice Address - Country:US
Practice Address - Phone:417-317-5330
Practice Address - Fax:417-763-3370
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020010636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine