Provider Demographics
NPI:1376846568
Name:OAK MEDICAL PRACTICE, P.C.
Entity Type:Organization
Organization Name:OAK MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OYINKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKORICHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-935-1625
Mailing Address - Street 1:2001 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4086
Mailing Address - Country:US
Mailing Address - Phone:575-935-1625
Mailing Address - Fax:575-935-1626
Practice Address - Street 1:2001 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4086
Practice Address - Country:US
Practice Address - Phone:575-935-1625
Practice Address - Fax:575-935-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty