Provider Demographics
NPI:1013930841
Name:OLIVER, KELTON HILLARD (MD)
Entity Type:Individual
Prefix:
First Name:KELTON
Middle Name:HILLARD
Last Name:OLIVER
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 1:12302 WOODWARD DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1957
Mailing Address - Country:US
Mailing Address - Phone:907-580-0002
Mailing Address - Fax:
Practice Address - Street 1:12302 WOODWARD DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1957
Practice Address - Country:US
Practice Address - Phone:907-580-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD6076Medicaid
AKF72669Medicare UPIN
AK8EB344Medicare ID - Type Unspecified