Provider Demographics
NPI:1689658254
Name:OLIVERE, ROBERT FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:OLIVERE
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 1:1401 W FRIER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-371-1455
Mailing Address - Fax:602-678-1747
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-249-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10637207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW1436OtherHEALTHNET GROUP NUMBER
AZ096702Medicaid
AZAZ0728670OtherBLUE CROSS BLUE SHIELD
AZ39-81220OtherEVERCARE GROUP NUMBER
AZ096702Medicaid
AZ28208Medicare ID - Type Unspecified