Provider Demographics
NPI:1043217664
Name:OLIVER, DAVID L (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7785
Mailing Address - Country:US
Mailing Address - Phone:360-423-0390
Mailing Address - Fax:360-577-3865
Practice Address - Street 1:1706 WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2952
Practice Address - Country:US
Practice Address - Phone:360-423-9580
Practice Address - Fax:360-423-6230
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0158033OtherLABOR & IND.
970025814OtherRR MEDICARE
WA8936700OtherCRIME VICTIMS
WA8330896Medicaid
WA8936700OtherCRIME VICTIMS
WA0158033OtherLABOR & IND.