Provider Demographics
NPI:1952634222
Name:OLIVER, PAXTON E II (MS)
Entity Type:Individual
Prefix:MR
First Name:PAXTON
Middle Name:E
Last Name:OLIVER
Suffix:II
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2006 GUS KAPLAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3376
Mailing Address - Country:US
Mailing Address - Phone:318-487-5395
Mailing Address - Fax:318-487-5463
Practice Address - Street 1:2006 GUS KAPLAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3376
Practice Address - Country:US
Practice Address - Phone:318-487-5395
Practice Address - Fax:318-487-5463
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities