Provider Demographics
NPI:1003844549
Name:SAMUEL D OLOYO MD PA
Entity Type:Organization
Organization Name:SAMUEL D OLOYO MD PA
Other - Org Name:SOUTH TEXAS MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLOYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-885-0075
Mailing Address - Street 1:2472 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405
Mailing Address - Country:US
Mailing Address - Phone:361-885-0075
Mailing Address - Fax:361-885-0308
Practice Address - Street 1:2472 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:361-885-0075
Practice Address - Fax:361-885-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00505UMedicare ID - Type Unspecified
G65513Medicare UPIN