Healthcare Provider Details

I. General information

NPI: 1194928234
Provider Name (Legal Business Name): JOHN R OLIVER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 E COUNTRY FIELD CIR STE D
WASILLA AK
99654-6659
US

IV. Provider business mailing address

PO BOX 871988
WASILLA AK
99687-1988
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-6121
  • Fax: 907-357-6171
Mailing address:
  • Phone: 907-357-6121
  • Fax: 907-357-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4950
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN R OLIVER
Title or Position: PHYSICIAN
Credential: MD
Phone: 907-357-6121