Provider Demographics
NPI:1194928234
Name:JOHN R OLIVER MD PC
Entity type:Organization
Organization Name:JOHN R OLIVER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-6121
Mailing Address - Street 1:3750 E COUNTRY FIELD CIR STE D
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6659
Mailing Address - Country:US
Mailing Address - Phone:907-357-6121
Mailing Address - Fax:907-357-6171
Practice Address - Street 1:3750 E COUNTRY FIELD CIR STE D
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6659
Practice Address - Country:US
Practice Address - Phone:907-357-6121
Practice Address - Fax:907-357-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4950207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F00845Medicare UPIN