Provider Demographics
NPI:1578729562
Name:OLIVER, SUSAN JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:767 PEARL ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5061
Mailing Address - Country:US
Mailing Address - Phone:303-440-5150
Mailing Address - Fax:303-449-5022
Practice Address - Street 1:767 PEARL ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5061
Practice Address - Country:US
Practice Address - Phone:303-440-5150
Practice Address - Fax:303-449-5022
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO252562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry