Individual
JOSE A. OLIVENCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2425 WESTOWN PKWY, WEST DES MOINES, IA 50266-1425
(515) 222-8346
(515) 222-0472
Mailing address
2425 WESTOWN PKWY, WEST DES MOINES, IA 50266-1425
(515) 222-8346
(515) 222-0472
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19393
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02396
WELLMARK
—
05
—
10025355600
—
NE
05
—
1151837
—
IA
01
—
1700237
UNITED HEALTHCARE
—
01
—
20015691
RAILROAD MEDICARE
—
01
—
663357
FIRST HEALTH
—
01
—
6702
MIDLANDS CHOICE
—
Enumeration date
08/17/2006
Last updated
07/08/2007
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