Healthcare Provider Details

I. General information

NPI: 1922038249
Provider Name (Legal Business Name): RANDALL L. OLIVER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8016
US

IV. Provider business mailing address

PO BOX 6810
EVANSVILLE IN
47719-0810
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-7246
  • Fax: 812-477-7240
Mailing address:
  • Phone: 812-477-7246
  • Fax: 812-477-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDALL LEE OLIVER
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 812-477-7246