Provider Demographics
NPI:1043746027
Name:OLIVO, PAUL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:OLIVO
Suffix:
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 1:639 W POLO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2635
Mailing Address - Country:US
Mailing Address - Phone:314-640-9732
Mailing Address - Fax:
Practice Address - Street 1:639 W POLO DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2635
Practice Address - Country:US
Practice Address - Phone:314-640-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8J70207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine