Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 4950 | AK |
NPI | 1093778029 |
---|---|
Provider Name | John Oliver |
First Address | Wasilla, AK 99687-5910 |
Second Address | Wasilla, AK 99654-7105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F00845 | (02) | AK |
MD5356 | (05) | AK |