MEDICARE: JOHN P OLIPHANT MD

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	2080A0000X	Pediatric Adolescent Medicine Physician	30518	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000052171	OTHER	ANTHEM
2	1124739	OTHER	PASSPORT
3	1200353	OTHER	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1194719831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P OLIPHANT MD

Provider Business Mailing Address
First Line	:	3427 STONY SPRING CIR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-5437
Country	:	US
Telephone Number	:	502-493-9994
Fax Number	:	502-493-9991

Provider Business Practice Location Address
First Line	:	3427 STONY SPRING CIR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-5437
Country	:	US
Telephone Number	:	502-493-9994
Fax Number	:	502-493-9991

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	02/24/2009

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