Organization
OASIS SURGICAL PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL A CARMICHAEL MD (CFO)
(209) 632-2960
Entity
Organization
Contact information
Practice address
880 E TUOLUMNE RD, SUITE 201, TURLOCK, CA 95382-1548
(209) 632-2960
(209) 632-2062
Mailing address
880 E TUOLUMNE RD, 201, TURLOCK, CA 95382-1548
(209) 632-2960
(209) 632-2062
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0100260
—
CA
01
—
ZZZ64148Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
05/25/2006
Last updated
07/11/2007
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