Healthcare Provider Details

I. General information

NPI: 1942262233
Provider Name (Legal Business Name): TODD M OLIVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/06/2007

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax: 573-443-0574
Mailing address:
  • Phone: 573-443-2402
  • Fax: 573-443-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2005035360
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2005035360
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: