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General NPI Number Information
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NPI Number | 1659869238
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Entity Type | Organization
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Legal Business Name | OASIS MEDICAL PROVIDERS, LLC
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Dates
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Enumeration Date | 04/29/2018
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Last Update Date | 04/29/2018
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Provider Practice Location Address
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Address Line | 316 PASEO REYES DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-8464
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Country | US
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Telephone | 904-342-0219
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Fax |
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Provider Business Mailing Address
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Address Line | 1096 DORADO DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-7075
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Country | US
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Telephone | 814-571-5504
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Fax |
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Authorized Official
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Title or Position | MANAGER/PROVIDER
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Name | MR. JOHN P CROYLE JR.
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Credential | PA-C
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Telephone | 814-571-5504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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