Provider Demographics
NPI:1891879219
Name:JOHN P OLIPHANT MD PLLC
Entity Type:Organization
Organization Name:JOHN P OLIPHANT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLIPHANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-493-9994
Mailing Address - Street 1:3427 STONY SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5437
Mailing Address - Country:US
Mailing Address - Phone:502-493-9994
Mailing Address - Fax:502-493-9991
Practice Address - Street 1:3427 STONY SPRING CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5437
Practice Address - Country:US
Practice Address - Phone:502-493-9994
Practice Address - Fax:502-493-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY305182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1200353OtherUNITED HEALTHCARE
KY000000052171OtherANTHEM
KY1124739OtherPASSPORT