MEDICARE: DR. EDDIE EUGENE OLIVER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME53972	FL

General Provider Information

NPI Number	:	1952469504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDIE EUGENE OLIVER MD

Provider Business Mailing Address
First Line	:	2470 WELLINGTON GREEN DR
Second Line	:	STE 308
City	:	WELLINGTON
State	:	FL
Zip	:	33414-9321
Country	:	US
Telephone Number	:	813-495-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S MAIN ST
Second Line	:
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-4911
Country	:	US
Telephone Number	:	561-996-6571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/08/2008

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