Healthcare Provider Details

I. General information

NPI: 1073247524
Provider Name (Legal Business Name): PAUL MICHAEL BEZAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S OAK AVE
OAKDALE CA
95361-3519
US

IV. Provider business mailing address

350 S OAK AVE
OAKDALE CA
95361-3519
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-3011
  • Fax: 209-410-6948
Mailing address:
  • Phone: 209-847-3011
  • Fax: 209-410-6948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: