Provider Demographics
NPI:1629069745
Name:OLIVER, HUGH WHITTINGTON (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:WHITTINGTON
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 1:2888 MAHAN DRIVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-942-2233
Mailing Address - Fax:850-942-1048
Practice Address - Street 1:2888 MAHAN DRIVE
Practice Address - Street 2:SUITE 6
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-942-2233
Practice Address - Fax:850-942-1048
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067029400Medicaid
FLK5641Medicare ID - Type Unspecified
FLD85678Medicare UPIN