Individual
DR. JONATHAN CHARLES OLIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 8TH ST S, MOORHEAD, MN 56560-3604
(701) 234-3100
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(701) 234-3100
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
13439
ND
2084P0800X
Psychiatry Physician
Primary
58826
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81888
—
ND
Enumeration date
03/30/2011
Last updated
03/25/2022
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