Provider Demographics
NPI:1588965636
Name:PETER T OAS PHD PA
Entity type:Organization
Organization Name:PETER T OAS PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:OAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-729-3117
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32588-1002
Mailing Address - Country:US
Mailing Address - Phone:850-729-3117
Mailing Address - Fax:850-729-3142
Practice Address - Street 1:707 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2589
Practice Address - Country:US
Practice Address - Phone:850-729-3117
Practice Address - Fax:850-729-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75695Medicare UPIN