Healthcare Provider Details

I. General information

NPI: 1740448224
Provider Name (Legal Business Name): OSCAR D ESPETIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NORTH PATTERSON STREET
VALDOSTA GA
31602
US

IV. Provider business mailing address

1613 N. HARRISON PKWY BLDG C STE 200
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-1000
  • Fax: 229-249-5098
Mailing address:
  • Phone: 800-437-2572
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN12330
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME110364
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number065358
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: