MEDICARE: DR. CAROLYN OLIVER

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	208D00000X	General Practice Physician	E8775	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00FE88	OTHER		BCBS PROVIDER #

General Provider Information

NPI Number	:	1669556825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN OLIVER

Provider Business Mailing Address
First Line	:	1458 CAMPBELL RD STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1458 CAMPBELL RD STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4654
Country	:	US
Telephone Number	:	713-461-2822
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/12/2007

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Directions to “ DR. CAROLYN OLIVER ” Practice Location

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