Provider Demographics
NPI:1164404455
Name:OLIVER, DAVID LUCIOUS (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LUCIOUS
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SE 28TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1080
Mailing Address - Country:US
Mailing Address - Phone:352-351-4634
Mailing Address - Fax:352-351-1900
Practice Address - Street 1:1750 SE 28TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1080
Practice Address - Country:US
Practice Address - Phone:352-351-4634
Practice Address - Fax:352-351-1900
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57170OtherBCBSFL
FL57170OtherBCBSFL