Healthcare Provider Details

I. General information

NPI: 1144212499
Provider Name (Legal Business Name): OAK STREET MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 OAK ST
EUGENE OR
97401-4043
US

IV. Provider business mailing address

1488 OAK ST
EUGENE OR
97401-4043
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-1577
  • Fax: 541-344-6176
Mailing address:
  • Phone: 541-683-1577
  • Fax: 541-344-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRAIG WARREN JACOBSON
Title or Position: PHYSICIAN / OWNER
Credential: M.D.
Phone: 541-683-1577