Provider Demographics
NPI:1194719831
Name:OLIPHANT, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:OLIPHANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3427 STONY SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5437
Mailing Address - Country:US
Mailing Address - Phone:502-493-9994
Mailing Address - Fax:502-493-9991
Practice Address - Street 1:3427 STONY SPRING CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5437
Practice Address - Country:US
Practice Address - Phone:502-493-9994
Practice Address - Fax:502-493-9991
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY305182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000052171OtherANTHEM
1124739OtherPASSPORT
1200353OtherUNITED HEALTHCARE