Healthcare Provider Details

I. General information

NPI: 1255759320
Provider Name (Legal Business Name): HUNTER OLIVER-ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 12/05/2021
Certification Date: 12/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVENUE S-321
SAN FRANCISCO CA
94143-0470
US

IV. Provider business mailing address

530 S COWLEY ST
SPOKANE WA
99202-1316
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1239
  • Fax:
Mailing address:
  • Phone: 415-476-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA139547
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD61201614
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: