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General NPI Number Information
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NPI Number | 1922038249
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Entity Type | Organization
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Legal Business Name | RANDALL L. OLIVER, M.D., P.C.
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1101 PROFESSIONAL BLVD
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City | EVANSVILLE
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State | IN
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Zip | 47714-8016
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Country | US
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Telephone | 812-477-7246
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Fax | 812-477-7240
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Provider Business Mailing Address
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Address Line | PO BOX 6810
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City | EVANSVILLE
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State | IN
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Zip | 47719-0810
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Country | US
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Telephone | 812-477-7246
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Fax | 812-477-7240
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | RANDALL LEE OLIVER
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Credential | M.D.
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Telephone | 812-477-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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