Individual
DR. LARRY D OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3302 W GOLF COURSE RD, SUITE 100, MIDLAND, TX 79703-5110
(432) 522-2304
(432) 522-2307
Mailing address
PO BOX 28007, PORTLAND, OR 97228-8007
(844) 540-8736
(602) 798-8267
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
F1867
TX
207RN0300X
Nephrology Physician
Primary
F1867
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110159822
RAILROAD MEDICARE
—
05
—
1304602-05
—
TX
05
—
130460205
—
TX
01
—
F1867
TEXAS MEDICAL LICENSE
TX
Enumeration date
08/21/2006
Last updated
11/18/2015
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