Provider Demographics
NPI:1780870089
Name:OAK TREE FAMILY PRACTICE, PA
Entity type:Organization
Organization Name:OAK TREE FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PONTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-514-7315
Mailing Address - Street 1:90 CYPRESS WAY E STE 10
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:239-514-7315
Mailing Address - Fax:239-592-5999
Practice Address - Street 1:90 CYPRESS WAY E STE 10
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-514-7315
Practice Address - Fax:239-592-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21553Medicare PIN