=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306903687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT F OLDT MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 12/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 W 5TH ST STE 180
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030-6563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-985-5599
-----------------------------------------------------
Fax | 805-985-2867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1555 W 5TH ST STE 180
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030-6563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-985-5599
-----------------------------------------------------
Fax | 805-985-2867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ROBERT F OLDT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 805-985-5599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------