Basic Information
| Provider Information | |||||||||
| NPI: | 1801903869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSLOS | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 NORTH CLYDE MORRIS BLVD., SUITE 200 | ||||||||
| Address2: | HALIFAX HEALTH MEDICAL CENTER | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862544165 | ||||||||
| FaxNumber: | 3862584891 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NORTH CLYDE MORRIS BLVD., SUITE 200 | ||||||||
| Address2: | HALIFAX HEALTH MEDICAL CENTER | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862544165 | ||||||||
| FaxNumber: | 3862584891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 03/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME35544 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 039153100 | 05 | FL | MEDICAID |