Individual
MR. JOSEPH EMILIAN OLLIVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
1147 SUNBURST ST, TWIN FALLS, ID 83301-3151
(208) 320-7250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA351
ID
363AM0700X
Medical Physician Assistant
PA-351
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010032406
BLUE SHIELD OF IDAHO
ID
01
—
000010032407
BLUE SHIELD OF IDAHO
ID
01
—
085960
BLUE SHIELD
ID
05
—
806032100
—
ID
05
—
806032101
—
ID
01
—
820227163G040
TRICARE
ID
01
—
PA351
STATE LICENSE
ID
01
—
PAIM4
BLUE CROSS OF IDAHO
ID
Enumeration date
01/25/2006
Last updated
08/17/2022
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