Provider Demographics
NPI:1265511406
Name:OLIPHANT, JOHN RHODES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RHODES
Last Name:OLIPHANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 S BUR OAK PLACE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2237
Mailing Address - Country:US
Mailing Address - Phone:605-373-0500
Mailing Address - Fax:605-361-6062
Practice Address - Street 1:5024 S BUR OAK PLACE
Practice Address - Street 2:SUITE 114
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2237
Practice Address - Country:US
Practice Address - Phone:605-373-0500
Practice Address - Fax:605-361-6062
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1913207Y00000X, 208200000X
SD4049207Y00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7301442Medicaid
4049OtherDAKOTA CARE
0040985OtherWELLMARK BCBS SD
22343OtherSIOUX VALLEY HEALTH PLAN
88330OtherHEALTHPARTNERS
B25254Medicare UPIN
SDS40985Medicare ID - Type Unspecified