Individual
OMAN E DEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1532 W 32ND ST, STE 401, JOPLIN, MO 64804-1607
(417) 347-7009
(417) 347-3288
Mailing address
1532 W 32ND ST, SUITE 401, JOPLIN, MO 64804-1607
(417) 347-7009
(417) 347-3288
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
34577
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010054250
RR MEDICARE
—
05
—
100142750B
—
KS
05
—
100177670A
—
OK
05
—
200882330
—
MO
01
—
6076
ANTHEM
MO
Enumeration date
06/27/2006
Last updated
08/17/2009
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