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General NPI Number Information
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NPI Number | 1437275880
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Entity Type | Individual
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Provider Name | RICHARD A OLDANO PA
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1300 BARRINGTON CIR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3612
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Country | US
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Telephone | 904-940-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 9826 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5438
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Country | US
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Telephone | 904-652-0370
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Fax | 904-652-0371
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2717
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License Number State | FL
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