Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | E-8983 | AR |
N | 208D00000X | General Practice Physician | 39020000X | VA |
NPI | 1265587869 |
---|---|
Provider Name | Dr. Saint Adeogba |
First Address | Little Rock, AR 72205-6205 |
Second Address | Little Rock, AR 72205-6205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 04/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265587869 | NPI (01) | AR |
208292001 | (05) | AR |
411432YNV5 | (02) | AR |