Provider Demographics
NPI:1629793138
Name:OATS, JEREMY MARVIN (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:MARVIN
Last Name:OATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:MAVIN
Other - Last Name:OATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1712 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-2805
Mailing Address - Country:US
Mailing Address - Phone:906-203-8439
Mailing Address - Fax:
Practice Address - Street 1:1712 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2805
Practice Address - Country:US
Practice Address - Phone:906-230-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)