MEDICARE: MARY K. OATES, M.D. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	GO72476	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	GO72477	CA

General Provider Information

NPI Number	:	1386652659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY K. OATES, M.D. INC

Provider Business Mailing Address
First Line	:	116 S PALISADE DR
Second Line	:	STE. #200
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-8904
Country	:	US
Telephone Number	:	805-922-4224
Fax Number	:	805-922-6101

Provider Business Practice Location Address
First Line	:	116 S PALISADE DR
Second Line	:	STE. #200
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-8904
Country	:	US
Telephone Number	:	805-922-4224
Fax Number	:	805-922-6101

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY KOSKO OATES
Credential	:	M.D.
Telephone Number	:	805-922-4224

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	02/19/2008

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