Healthcare Provider Details

I. General information

NPI: 1386661478
Provider Name (Legal Business Name): DOLORES C OLIVAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

IV. Provider business mailing address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-0480
  • Fax: 812-522-0195
Mailing address:
  • Phone: 812-522-0480
  • Fax: 812-522-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01039545A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: