Basic Information
Provider Information
NPI: 1982683884
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLIVER
FirstName: PAULA
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8701 SHOAL CREEK BLVD
Address2: SUITE 201
City: AUSTIN
State: TX
PostalCode: 787576864
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3705 MEDICAL PKWY
Address2: SUITE 250
City: AUSTIN
State: TX
PostalCode: 787051019
CountryCode: US
TelephoneNumber: 5123021210
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/10/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XJ2715TXY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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