=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386979540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKLAND MED GROUP CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2009
-----------------------------------------------------
Last Update Date | 01/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 W OAKLAND PARK BLVD SUITE B-104
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-626-0352
-----------------------------------------------------
Fax | 954-626-0354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 W OAKLAND PARK BLVD SUITE B-104
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-626-0352
-----------------------------------------------------
Fax | 954-626-0354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. EDGAR N ESCOBAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-626-0352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME65056
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------