Organization
ORTHOSPORTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIAN C OLIVER MD (ORTHPEDIC SURGEON)
(727) 725-6231
Entity
Organization
Contact information
Practice address
3251 MCMULLEN BOOTH ROAD, SUITE 201, CLEARWATER, FL 33761
(727) 725-6231
(727) 791-4563
Mailing address
3251 MCMULLEN BOOTH ROAD, SUITE 201, CLEARWATER, FL 33761
(727) 725-6231
(727) 791-4563
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051214100
—
FL
01
—
10411
BLUE SHIELD
FL
01
—
1688827008
CIGNA
FL
01
—
219099
AVMED
FL
01
—
2374595
AETNA HMO PVN
FL
01
—
7731133
AETNA PPO/MC PIN
FL
Enumeration date
06/02/2006
Last updated
11/12/2008
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