Provider Demographics
NPI:1467470245
Name:OLIVER, TINA (DPM)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 BLODGETT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5254
Mailing Address - Country:US
Mailing Address - Phone:713-661-3393
Mailing Address - Fax:713-661-3394
Practice Address - Street 1:2309 BLODGETT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5254
Practice Address - Country:US
Practice Address - Phone:713-661-3393
Practice Address - Fax:713-661-3394
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU13255Medicare UPIN