Provider Demographics
NPI:1467458042
Name:OLIVER, BRETT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALAN
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:210 BEVINS LN
Mailing Address - Street 2:STE C
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6127
Mailing Address - Country:US
Mailing Address - Phone:502-868-0622
Mailing Address - Fax:
Practice Address - Street 1:210 BEVINS LN
Practice Address - Street 2:STE C
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6120
Practice Address - Country:US
Practice Address - Phone:502-868-0622
Practice Address - Fax:502-868-9097
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64019862Medicaid
KY64019862Medicaid
KYP400030794Medicare PIN