Provider Demographics
NPI:1538134523
Name:OLIVER, JEFFREY D (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:10401 W THUNDERBIRD BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3004
Practice Address - Country:US
Practice Address - Phone:602-263-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18827207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7112OtherHEALTH NET AZ-SUN CITY PA
AZAX4478OtherHEALTH NET AZ-PATH ASSOC
AZAZ0828940OtherBCBSAZ-SUN CITY PATH
AZ109810Medicaid
AZ0182900OtherBCBSAZ-PATH ASSOC
AZ0182900OtherBCBSAZ-PATH ASSOC
AZ220024106Medicare PIN
AZ220009982Medicare PIN
AZZ23884Medicare PIN
AZZ33WCGNG1LMedicare PIN
AZ129489Medicare PIN