Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 13925 | WV |
NPI | 1053497453 |
---|---|
Provider Name | Ross Samuel Oliver JR. |
First Address | Charleston, WV 25304-1066 |
Second Address | Charleston, WV 25304-1066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 14/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001721031 | BC BS (01) | WV |
0130039000 | (05) | WV |
0216253040000 | TRICARE (01) | WV |
1002718509 | ACORDIA PEIA (01) | WV |
1393063 | MC UMW (01) | WV |
1508836 | CIGNA (01) | WV |
185112 | SELECT NET (01) | WV |
221960 | CARELINK (01) | WV |
340002703 | RAILROAD MC (01) | WV |
4242731 | AETNA (01) | WV |
D98066 | (02) | |
D98066 | (02) | WV |