=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548245822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRY D. OLIVER, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2005
-----------------------------------------------------
Last Update Date | 12/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1416 CALHOUN ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-252-5791
-----------------------------------------------------
Fax | 803-254-7215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1416 CALHOUN ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-252-5791
-----------------------------------------------------
Fax | 803-254-7215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARRY DURAND OLIVER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 803-252-5791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 14795
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------