Healthcare Provider Details

I. General information

NPI: 1316387327
Provider Name (Legal Business Name): CHRISTIAN OLIVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DE PAUL DR STE 120
BRIDGETON MO
63044-2513
US

IV. Provider business mailing address

PO BOX 3891
CHESTERFIELD MO
63006-3891
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2019033230
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number308900
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: