Provider Demographics
NPI:1932476132
Name:OBIOZO, ALBERT O (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:O
Last Name:OBIOZO
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 1:615 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4557
Mailing Address - Country:US
Mailing Address - Phone:870-444-5147
Mailing Address - Fax:870-444-5129
Practice Address - Street 1:615 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4557
Practice Address - Country:US
Practice Address - Phone:870-444-5147
Practice Address - Fax:870-444-5129
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics