Healthcare Provider Details

I. General information

NPI: 1326181777
Provider Name (Legal Business Name): MICHAEL LEE OLIVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E PECAN ST
ALTUS OK
73521-6192
US

IV. Provider business mailing address

1200 E PECAN ST
ALTUS OK
73521-6192
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-5000
  • Fax: 580-379-5509
Mailing address:
  • Phone: 580-379-5000
  • Fax: 580-379-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3686
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3686
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: