Provider Demographics
NPI:1073276234
Name:OATES, BYRAN (PRESIDENT)
Entity Type:Individual
Prefix:MR
First Name:BYRAN
Middle Name:
Last Name:OATES
Suffix:
Gender:M
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E MAIN ST
Mailing Address - Street 2:SUITE 1000 PMB #4049
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2645
Mailing Address - Country:US
Mailing Address - Phone:804-415-6777
Mailing Address - Fax:
Practice Address - Street 1:919 E MAIN ST
Practice Address - Street 2:SUITE 1000 PMB #4049
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2645
Practice Address - Country:US
Practice Address - Phone:804-415-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67118338172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver