Provider Demographics
NPI:1619995057
Name:WOLIVER, THOMAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:WOLIVER
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 1:540 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4230
Mailing Address - Country:US
Mailing Address - Phone:805-563-5800
Mailing Address - Fax:805-898-3614
Practice Address - Street 1:540 WEST PUEBLO STREET
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4230
Practice Address - Country:US
Practice Address - Phone:805-563-5800
Practice Address - Fax:805-898-3614
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39797207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G397970Medicaid
C46545Medicare UPIN