Healthcare Provider Details

I. General information

NPI: 1275512295
Provider Name (Legal Business Name): ARCADIO J OLIVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

PO BOX 537046
ATLANTA GA
30353-7046
US

V. Phone/Fax

Practice location:
  • Phone: 912-261-2669
  • Fax:
Mailing address:
  • Phone: 912-261-2669
  • Fax: 912-261-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101041969
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME53804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: