Healthcare Provider Details

I. General information

NPI: 1043174345
Provider Name (Legal Business Name): PAUL OLIVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 BRENTON DR
NEWARK OH
43055-3420
US

IV. Provider business mailing address

84 BRENTON DR
NEWARK OH
43055-3420
US

V. Phone/Fax

Practice location:
  • Phone: 740-334-8807
  • Fax:
Mailing address:
  • Phone: 740-334-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: