Individual
DR. BRAD DAVID OLIVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3269 STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Mailing address
3269 STOCKTON HILL RD, KINGMAN, AZ 86409-3619
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PG158047
OR
207P00000X
Emergency Medicine Physician
Primary
R2303
AZ
Other
Enumeration date
06/22/2012
Last updated
10/25/2013
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