Active NPI
Oak Valley Otolaryngology Inc
- Otolaryngology Physician
- Oakdale, CA
National Provider Identifier
1659667285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- Legal business name
- OAK VALLEY OTOLARYNGOLOGY INC
- Practice address
- 250 S Oak Ave
Suite 4
Oakdale, CA 95361-3572 - Phone
- (209) 845-0100
- Fax
- (209) 845-0130
- NPI assigned
- Jun 22, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jerrold Polterock, MD
- Title
- MD/President
- Phone
- (209) 845-0100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | Primary |
Addresses
Primary practice location
250 S Oak Ave
Suite 4
Oakdale, CA 95361-3572
Mailing address
250 S Oak Ave
Suite 4
Oakdale, CA 95361-3572
Phone (209) 845-0100
National Provider Directory
National Provider DirectoryLocations
250 S Oak Ave
Ste 4
Oakdale, CA 95361
Phone (209) 845-0100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1312761600000",
"number": "1659667285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 S OAK AVE",
"address_2": "SUITE 4",
"city": "OAKDALE",
"state": "CA",
"postal_code": "953613572",
"telephone_number": "209-845-0100",
"fax_number": "209-845-0130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 S OAK AVE",
"address_2": "SUITE 4",
"city": "OAKDALE",
"state": "CA",
"postal_code": "953613572",
"telephone_number": "209-845-0100",
"fax_number": "209-845-0130"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OAK VALLEY OTOLARYNGOLOGY INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-06-22",
"last_updated": "2011-08-08",
"status": "A",
"authorized_official_last_name": "POLTEROCK",
"authorized_official_first_name": "JERROLD",
"authorized_official_title_or_position": "MD/PRESIDENT",
"authorized_official_telephone_number": "209-845-0100",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.