Provider Demographics
NPI:1871923177
Name:OLIVER, DOROTHY C
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:C
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:LA
Mailing Address - Zip Code:71326-5012
Mailing Address - Country:US
Mailing Address - Phone:318-758-2905
Mailing Address - Fax:318-389-4815
Practice Address - Street 1:8939 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:LA
Practice Address - Zip Code:71326-5012
Practice Address - Country:US
Practice Address - Phone:318-758-2905
Practice Address - Fax:318-389-4815
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1003671Medicare PIN