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General NPI Number Information
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NPI Number | 1780870089
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Entity Type | Organization
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Legal Business Name | OAK TREE FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 90 CYPRESS WAY E STE 10
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City | NAPLES
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State | FL
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Zip | 34110-9275
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Country | US
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Telephone | 239-514-7315
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Fax | 239-592-5999
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Provider Business Mailing Address
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Address Line | 90 CYPRESS WAY E STE 10
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City | NAPLES
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State | FL
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Zip | 34110-9275
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Country | US
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Telephone | 239-514-7315
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Fax | 239-592-5999
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. NOELL J PONTO
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Credential |
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Telephone | 239-514-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8202
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License Number State | FL
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