Healthcare Provider Details

I. General information

NPI: 1730498437
Provider Name (Legal Business Name): NOAH GENE OLIVER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RUE LOUIS XIV STE 101
LAFAYETTE LA
70508-5738
US

IV. Provider business mailing address

PO BOX 159
OPELOUSAS LA
70571-0159
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-9993
  • Fax: 337-269-0316
Mailing address:
  • Phone: 337-942-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM200070
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: