Provider Demographics
NPI:1578674479
Name:OLIVER, GERALD D (MD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055A SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5884
Mailing Address - Country:US
Mailing Address - Phone:803-648-3500
Mailing Address - Fax:803-648-4200
Practice Address - Street 1:1055A SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5884
Practice Address - Country:US
Practice Address - Phone:803-648-3500
Practice Address - Fax:803-648-4200
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18511207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT24630Medicaid
SCA747100281Medicare PIN
SCT24630Medicaid