Healthcare Provider Details

I. General information

NPI: 1437323334
Provider Name (Legal Business Name): JOSEPH J. OLIVER MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 HILLTOP DR SUITE 103
ROCK SPRINGS WY
82901-5861
US

IV. Provider business mailing address

1204 HILLTOP DR SUITE 103
ROCK SPRINGS WY
82901-5861
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-7745
  • Fax: 307-382-6615
Mailing address:
  • Phone: 307-362-7745
  • Fax: 307-382-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2629A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH J. OLIVER
Title or Position: PHYSICIAN
Credential: MD,PC
Phone: 307-362-7745