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General NPI Number Information
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NPI Number | 1891879219
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Entity Type | Organization
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Legal Business Name | JOHN P OLIPHANT MD PLLC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 3427 STONY SPRING CIR
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City | LOUISVILLE
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State | KY
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Zip | 40220-5437
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Country | US
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Telephone | 502-493-9994
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Fax | 502-493-9991
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Provider Business Mailing Address
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Address Line | 3427 STONY SPRING CIR
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City | LOUISVILLE
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State | KY
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Zip | 40220-5437
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Country | US
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Telephone | 502-493-9994
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Fax | 502-493-9991
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Authorized Official
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Title or Position | SOLE MEMBER OWNER
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Name | JOHN P OLIPHANT
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Credential | MD
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Telephone | 502-493-9994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 30518
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License Number State | KY
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