MEDICARE: OLIVER C JAMES II 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	207L00000X	Anesthesiology Physician	29049	KY
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	29049	KY
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	29049	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194727701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER C JAMES II M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22756
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40522-2756
Country	:	US
Telephone Number	:	859-264-1815
Fax Number	:	859-264-1820

Provider Business Practice Location Address
First Line	:	120 PROSPEROUS PL STE 102
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1866
Country	:	US
Telephone Number	:	859-967-5309
Fax Number	:	859-967-5346

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	04/07/2023

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