Provider Demographics
NPI:1588648687
Name:OLIVEIRA, CARLOS MARIO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MARIO
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:MARIO
Other - Last Name:OLIVEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1223 GATEWAY DR STE 1D
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-312-3480
Practice Address - Fax:321-722-1237
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36302207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01164169OtherRR MEDICARE
FL05434OtherBCBS OF FLORIDA
FL160034381OtherRR MEDICARE
FL065583000Medicaid
FL05434YOtherFL MEDICARE