Provider Demographics
NPI:1467425785
Name:OLIVER, JAMES (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-617-1227
Mailing Address - Fax:702-384-7139
Practice Address - Street 1:2845 SIENA HEIGHTS DR
Practice Address - Street 2:SOUTHWEST MEDICAL ASSOCIATES
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-617-1227
Practice Address - Fax:702-384-7139
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV922207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018457Medicaid
NV1467425785Medicaid
NV3102457Medicaid
G03317Medicare UPIN
NV3102457Medicaid