Healthcare Provider Details

I. General information

NPI: 1326253444
Provider Name (Legal Business Name): LISA COFFEY OLIVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 S MAIN ST STE A
COTTONWOOD AZ
86326-4602
US

IV. Provider business mailing address

989 S MAIN ST STE A
COTTONWOOD AZ
86326-4602
US

V. Phone/Fax

Practice location:
  • Phone: 928-679-3911
  • Fax:
Mailing address:
  • Phone: 928-679-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number37680
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: