Healthcare Provider Details

I. General information

NPI: 1356781199
Provider Name (Legal Business Name): WILLIAM OLIVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SPENCER RD
SPENCER OK
73084-3649
US

IV. Provider business mailing address

13821 TECHNOLOGY DR STE B
OKLAHOMA CITY OK
73134-1046
US

V. Phone/Fax

Practice location:
  • Phone: 405-427-2441
  • Fax: 405-427-4741
Mailing address:
  • Phone: 405-451-3454
  • Fax: 405-427-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number32105
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036139372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: