Provider Demographics
NPI:1346230596
Name:OLLIVIERRE, CARL O (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:O
Last Name:OLLIVIERRE
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 1:600 NORTH BLVD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5063
Mailing Address - Country:US
Mailing Address - Phone:352-728-3000
Mailing Address - Fax:352-787-6890
Practice Address - Street 1:600 NORTH BLVD W
Practice Address - Street 2:SUITE C
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-728-3000
Practice Address - Fax:352-787-6890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062348207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29370Medicare UPIN
FL15147ZMedicare ID - Type Unspecified