Healthcare Provider Details

I. General information

NPI: 1730135773
Provider Name (Legal Business Name): OASIS SURGICAL PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 E TUOLUMNE RD SUITE 201
TURLOCK CA
95382-1548
US

IV. Provider business mailing address

880 E TUOLUMNE RD 201
TURLOCK CA
95382-1548
US

V. Phone/Fax

Practice location:
  • Phone: 209-632-2960
  • Fax: 209-632-2062
Mailing address:
  • Phone: 209-632-2960
  • Fax: 209-632-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL A CARMICHAEL
Title or Position: CFO
Credential: MD
Phone: 209-632-2960