Provider Demographics
NPI:1730258831
Name:OLIVER, ROBERT P (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
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 1:5 ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8079
Mailing Address - Country:US
Mailing Address - Phone:662-378-8000
Mailing Address - Fax:662-378-8000
Practice Address - Street 1:5 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8079
Practice Address - Country:US
Practice Address - Phone:662-378-8000
Practice Address - Fax:662-378-8000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS115442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1392120Medicaid
AR113889001Medicaid
P00275313OtherRR MEDICARE
MS00118393Medicaid
AR113889001Medicaid
MS300001017Medicare ID - Type Unspecified
LA1392120Medicaid