Individual
CHAD OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3800 S NATIONAL AVE FL 4, SPRINGFIELD, MO 65807-5209
(417) 875-2622
(417) 875-3718
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3462
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2020010074
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220083129
—
MO
Enumeration date
03/27/2020
Last updated
05/14/2020
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