Provider Demographics
NPI:1730498437
Name:OLIVER, NOAH GENE (DPM)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:GENE
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0159
Mailing Address - Country:US
Mailing Address - Phone:337-942-7567
Mailing Address - Fax:
Practice Address - Street 1:127 RUE LOUIS XIV STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5738
Practice Address - Country:US
Practice Address - Phone:337-269-9993
Practice Address - Fax:337-269-0316
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM200070213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2374168Medicaid
MS08101049Medicaid
MS08101049Medicaid