Healthcare Provider Details

I. General information

NPI: 1053320515
Provider Name (Legal Business Name): HOWARD G OAKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 MEDICAL DR
FAYETTEVILLE NC
28304-4418
US

IV. Provider business mailing address

1317 MEDICAL DR
FAYETTEVILLE NC
28304-4418
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-3890
  • Fax: 910-323-4509
Mailing address:
  • Phone: 910-323-3890
  • Fax: 910-323-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number9600348
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: