Provider Demographics
NPI:1194727701
Name:JAMES, OLIVER C II (MD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:C
Last Name:JAMES
Suffix:II
Gender:M
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 22756
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40522-2756
Mailing Address - Country:US
Mailing Address - Phone:859-264-1815
Mailing Address - Fax:859-264-1820
Practice Address - Street 1:120 PROSPEROUS PL STE 102
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1866
Practice Address - Country:US
Practice Address - Phone:859-967-5309
Practice Address - Fax:859-967-5346
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29049207L00000X, 2083A0300X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64053952Medicaid
KYF31702Medicare UPIN
KY64053952Medicaid
TN103I720561Medicare PIN
KY0719602Medicare ID - Type Unspecified
KYK113650Medicare PIN
KY64053952Medicaid