Provider Demographics
NPI:1659639672
Name:OLIVER, ANDREW J (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:436 NOKOMIS AVE S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2617
Mailing Address - Country:US
Mailing Address - Phone:941-445-5054
Mailing Address - Fax:941-303-6796
Practice Address - Street 1:436 NOKOMIS AVE S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2617
Practice Address - Country:US
Practice Address - Phone:941-445-5054
Practice Address - Fax:941-303-6796
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOS21972208600000X
WAOP60832942208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2120829Medicaid