Provider Demographics
NPI:1417461500
Name:DR ALBERT OBIOZO PEDIATRICS INC
Entity type:Organization
Organization Name:DR ALBERT OBIOZO PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIOZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-228-6579
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty