MEDICARE: DR. GARY NIEL OAKS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	364378-0501	UT
2	213ES0103X	Foot & Ankle Surgery Podiatrist	364378-0501	UT

General Provider Information

NPI Number	:	1922294768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY NIEL OAKS DPM

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-0337
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:	801-525-8151

Provider Business Practice Location Address
First Line	:	2178 S 900 E STE 1
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2388
Country	:	US
Telephone Number	:	801-466-1333
Fax Number	:	801-466-6601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	06/23/2016

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