Provider Demographics
NPI:1295787794
Name:OLIVER, LAWRENCE G (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:OLIVER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 NEBRASKA AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-465-4499
Mailing Address - Fax:772-465-5941
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-4499
Practice Address - Fax:772-465-5941
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-12-03
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Provider Licenses
StateLicense IDTaxonomies
FLME 57917207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11647XMedicare PIN