Provider Demographics
NPI:1114021581
Name:OLIVIER, GEORGE F (P-AC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:F
Last Name:OLIVIER
Suffix:
Gender:M
Credentials:P-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3801
Mailing Address - Country:US
Mailing Address - Phone:217-431-2025
Mailing Address - Fax:217-431-0014
Practice Address - Street 1:511 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3801
Practice Address - Country:US
Practice Address - Phone:217-431-2025
Practice Address - Fax:217-431-0014
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002794363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85002794OtherSTATE LICENSE NUMBER