Provider Demographics
NPI:1043305139
Name:OLIVER, ROBERT I SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:OLIVER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 STONEGATE TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VESTAVIA HLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2246
Mailing Address - Country:US
Mailing Address - Phone:205-298-8660
Mailing Address - Fax:205-298-8664
Practice Address - Street 1:2000 STONEGATE TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2246
Practice Address - Country:US
Practice Address - Phone:205-298-8660
Practice Address - Fax:205-298-8664
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000004748Medicaid
AL51004748OtherBCBS OF AL
AL51549597OtherBCBS OF AL
AL51012357OtherBCBS OF AL
AL000004748Medicaid
AL51012357OtherBCBS OF AL