Basic Information
| Provider Information | |||||||||
| NPI: | 1235664699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | TIMOTHY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 N CAMPBELL AVE RM 4334 | ||||||||
| Address2: | PO BOX 245058 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857245058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206262247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097720531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R76116 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 207T00000X | BP10064494 | TX | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.