Provider Demographics
NPI:1649218744
Name:OLIVER, JILL ALLISON (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ALLISON
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 S RAINBOW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4203
Mailing Address - Country:US
Mailing Address - Phone:702-568-5660
Mailing Address - Fax:702-568-5661
Practice Address - Street 1:5990 S RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4203
Practice Address - Country:US
Practice Address - Phone:702-568-5660
Practice Address - Fax:702-568-5661
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV127463207Q00000X
NV11484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11484OtherNV STATE BOARD OF MED EX
NV127463OtherABFM
NV127463OtherABFM
NV150829Medicare UPIN