Healthcare Provider Details

I. General information

NPI: 1437368578
Provider Name (Legal Business Name): SHELLEY M OLIVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E. HARMONY RD. STE 290
FORT COLLINS CO
80528
US

IV. Provider business mailing address

2121 E. HARMONY RD. STE 290
FORT COLLINS CO
80528
US

V. Phone/Fax

Practice location:
  • Phone: 970-224-9890
  • Fax: 970-224-9800
Mailing address:
  • Phone: 970-224-9890
  • Fax: 970-224-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301088465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: