Provider Demographics
NPI:1306903687
Name:ROBERT F OLDT MD INC
Entity type:Organization
Organization Name:ROBERT F OLDT MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-985-5599
Mailing Address - Street 1:1555 W 5TH ST STE 180
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6563
Mailing Address - Country:US
Mailing Address - Phone:805-985-5599
Mailing Address - Fax:805-985-2867
Practice Address - Street 1:1555 W 5TH ST STE 180
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6563
Practice Address - Country:US
Practice Address - Phone:805-985-5599
Practice Address - Fax:805-985-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087750Medicaid
CAAS811Medicare PIN