Provider Demographics
NPI:1598914970
Name:OLIVER ELIZABETH, TONY IYNAS (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:IYNAS
Last Name:OLIVER ELIZABETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:IYNAS
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1305 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011022968207R00000X, 208M00000X
SD9197208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1598914970Medicaid
IL1598914970Medicaid
IL1598914970Medicaid