Provider Demographics
NPI:1073599411
Name:OLIVER, GARY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:535 MILLER AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2905
Mailing Address - Country:US
Mailing Address - Phone:415-413-6100
Mailing Address - Fax:415-383-1275
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-994-3238
Practice Address - Fax:650-991-1119
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-01-11
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Provider Licenses
StateLicense IDTaxonomies
CAA100223207N00000X, 207ZD0900X, 207ZP0101X
OH35-076715-O207ZD0900X
OH35076715O207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01337Medicare UPIN