Provider Demographics
NPI:1558683904
Name:SERGE, OSWALDO (CSA)
Entity Type:Individual
Prefix:
First Name:OSWALDO
Middle Name:
Last Name:SERGE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7564
Mailing Address - Country:US
Mailing Address - Phone:507-206-3077
Mailing Address - Fax:
Practice Address - Street 1:4036 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7564
Practice Address - Country:US
Practice Address - Phone:507-206-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical