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General NPI Number Information
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NPI Number | 1841388964
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Entity Type | Organization
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Legal Business Name | OAKDALE FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N SUITE 403
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2948
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Country | US
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Telephone | 763-529-9131
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Fax | 763-529-5519
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Provider Business Mailing Address
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Address Line | 3366 OAKDALE AVE N SUITE 403
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2948
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Country | US
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Telephone | 763-529-9131
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Fax | 763-529-5519
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Authorized Official
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Title or Position | OWNER
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Name | DR. GENE WAYNE VELASCO
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Credential | MD
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Telephone | 763-529-9131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 24D0670882
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License Number State | MN
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