Provider Demographics
NPI:1467443184
Name:OLIVER, JOHN G (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-0636
Mailing Address - Country:US
Mailing Address - Phone:336-838-5121
Mailing Address - Fax:336-667-5756
Practice Address - Street 1:408 8TH ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4167
Practice Address - Country:US
Practice Address - Phone:336-838-5121
Practice Address - Fax:336-667-5756
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC24024207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8964063Medicaid
64063OtherBCBS
C81161Medicare UPIN
202250Medicare ID - Type Unspecified