Provider Demographics
NPI:1568586543
Name:OLIVER, EDWARD (LMT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9556 E KIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5557
Mailing Address - Country:US
Mailing Address - Phone:602-432-1214
Mailing Address - Fax:
Practice Address - Street 1:9556 E KIMBERLY WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5557
Practice Address - Country:US
Practice Address - Phone:602-432-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-04934P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist