Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 48721 | MN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 74669 | WI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | PT10369 | ND |
NPI | 1154404598 |
---|---|
Provider Name | Terry Paul Olivas |
First Address | Weston, WI 54476-5220 |
Second Address | Weston, WI 54476-5220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G94865 | (02) |