MEDICARE: GREGORY ALLEN OLIVER D.O.

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	207Q00000X	Family Medicine Physician	02000756A	IN

General Provider Information

NPI Number	:	1285638254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY ALLEN OLIVER D.O.

Provider Business Mailing Address
First Line	:	5645 LAFAYETTE RD STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1103
Country	:	US
Telephone Number	:	317-387-3050
Fax Number	:	317-295-7044

Provider Business Practice Location Address
First Line	:	5645 LAFAYETTE RD STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1103
Country	:	US
Telephone Number	:	317-387-3050
Fax Number	:	317-295-7044

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	09/21/2012

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