Healthcare Provider Details

I. General information

NPI: 1609812965
Provider Name (Legal Business Name): PETER FORREST OLIVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249
US

IV. Provider business mailing address

PO BOX 636
SAN ANDREAS CA
95249
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-0870
  • Fax: 209-754-0878
Mailing address:
  • Phone: 209-754-0870
  • Fax: 209-754-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG65894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: