Individual
OLIVER JAMES FACKELMAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 E MAXWELL ST STE 302, LEXINGTON, KY 40508-2678
(859) 218-2774
(859) 323-6727
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
54895
KY
208600000X
Surgery Physician
A166863
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CO
Other
Enumeration date
04/06/2015
Last updated
08/31/2021
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