Provider Demographics
NPI:1154391191
Name:OLIVERAS, ODETTE (MD)
Entity type:Individual
Prefix:DR
First Name:ODETTE
Middle Name:
Last Name:OLIVERAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-247-4240
Mailing Address - Fax:515-247-4239
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-247-4240
Practice Address - Fax:515-247-4239
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-41089207R00000X
NJMA70228207R00000X
FLME 96999207R00000X
IA41089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA70228OtherMEDICAL LICENSE
FLME96999OtherFL LICENSE
IA41089OtherMEDICAL LICENSE