MEDICARE: PAUL DAVID OLIVO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R8J70	MO

General Provider Information

NPI Number	:	1043746027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DAVID OLIVO M.D.

Provider Business Mailing Address
First Line	:	639 W POLO DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-2635
Country	:	US
Telephone Number	:	314-640-9732
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 W POLO DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-2635
Country	:	US
Telephone Number	:	314-640-9732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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