Provider Demographics
NPI:1235392309
Name:OLIVERO LARA, HUMBERTO JOSE (MD, MSPH)
Entity Type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:JOSE
Last Name:OLIVERO LARA
Suffix:
Gender:M
Credentials:MD, MSPH
Other - Prefix:MR
Other - First Name:HUMBERTO
Other - Middle Name:JOSE
Other - Last Name:OLIVERO L.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MSPH
Mailing Address - Street 1:611 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645
Mailing Address - Country:US
Mailing Address - Phone:573-783-3341
Mailing Address - Fax:573-783-1096
Practice Address - Street 1:611 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645
Practice Address - Country:US
Practice Address - Phone:573-783-3341
Practice Address - Fax:573-783-1096
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO20140252242083X0100X, 2083P0901X, 202C00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine