Provider Demographics
NPI:1700878634
Name:ASEMOTA, OBOMA STEVE (MD)
Entity Type:Individual
Prefix:
First Name:OBOMA
Middle Name:STEVE
Last Name:ASEMOTA
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:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-0725
Mailing Address - Country:US
Mailing Address - Phone:870-382-4220
Mailing Address - Fax:870-382-6636
Practice Address - Street 1:206 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2339
Practice Address - Country:US
Practice Address - Phone:870-222-3644
Practice Address - Fax:870-222-3682
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4419208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122216001Medicaid
AR122216001Medicaid
55987Medicare ID - Type Unspecified