Basic Information
| Provider Information | |||||||||
| NPI: | 1629069745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | HUGH | ||||||||
| MiddleName: | WHITTINGTON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2888 MAHAN DRIVE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509422233 | ||||||||
| FaxNumber: | 8509421048 | ||||||||
| Practice Location | |||||||||
| Address1: | 2888 MAHAN DRIVE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509422233 | ||||||||
| FaxNumber: | 8509421048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0037036 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 067029400 | 05 | FL | MEDICAID |