Provider Demographics
NPI:1326118555
Name:OLDHAM, DAVID MERRILL (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MERRILL
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 7TH ST BLDG 700
Mailing Address - Street 2:
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-327-7758
Mailing Address - Fax:478-327-7585
Practice Address - Street 1:655 7TH ST BLDG 700-A78
Practice Address - Street 2:
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-7758
Practice Address - Fax:478-327-7585
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10960787-12042083X0100X
NE455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine