Provider Demographics
NPI:1033169818
Name:OLAYA, BERNARDO (MD PA)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:
Last Name:OLAYA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4106
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0106
Mailing Address - Country:US
Mailing Address - Phone:940-766-6500
Mailing Address - Fax:940-766-6506
Practice Address - Street 1:2211 MIDWESTERN PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2300
Practice Address - Country:US
Practice Address - Phone:940-766-6500
Practice Address - Fax:940-766-6506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8740207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111702004Medicaid
TX8AJ784OtherBLUE CROSS/BLUE SHIELD
TXB25257Medicare UPIN
TX111702004Medicaid
TX611481Medicare PIN