Provider Demographics
NPI:1043201031
Name:OLIVERI, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:OLIVERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 370183
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0183
Mailing Address - Country:US
Mailing Address - Phone:702-778-9300
Mailing Address - Fax:702-778-9301
Practice Address - Street 1:851 S RAMPART BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4882
Practice Address - Country:US
Practice Address - Phone:702-778-9300
Practice Address - Fax:702-778-9301
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV6819208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019331Medicaid
NV002019331Medicaid
NVF01894Medicare UPIN
NVVMD6819Medicare PIN