Provider Demographics
NPI:1164539631
Name:OLIVER, QIAN ZHOU (MD)
Entity Type:Individual
Prefix:DR
First Name:QIAN
Middle Name:ZHOU
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:QIAN
Other - Middle Name:
Other - Last Name:ZHOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0387
Mailing Address - Fax:
Practice Address - Street 1:815 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2224
Practice Address - Country:US
Practice Address - Phone:817-321-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL78322085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158932703Medicaid
TX8L20262Medicare PIN
TXTXB120138Medicare PIN
TX158932703Medicaid
TX8L23223Medicare PIN
TXTXB120138Medicare PIN