Provider Demographics
NPI:1851390645
Name:OLIVE, PAUL MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MILTON
Last Name:OLIVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3126 S JACKSON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2534
Mailing Address - Country:US
Mailing Address - Phone:417-625-2278
Mailing Address - Fax:417-625-2277
Practice Address - Street 1:3126 S JACKSON AVE
Practice Address - Street 2:STE 200
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2534
Practice Address - Country:US
Practice Address - Phone:417-625-2278
Practice Address - Fax:417-625-2277
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMD36627207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202825329Medicaid
KS200964590AMedicaid
KS200964590AMedicaid
MOMA2082293Medicare PIN