Provider Demographics
NPI:1083955181
Name:ESIQUIEL P. OLIVAREZ, JR
Entity Type:Organization
Organization Name:ESIQUIEL P. OLIVAREZ, JR
Other - Org Name:4HEALTHFMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ESIQUIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLIVAREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:817-292-5000
Mailing Address - Street 1:6138 WALRAVEN CIR
Mailing Address - Street 2:STE A&B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2769
Mailing Address - Country:US
Mailing Address - Phone:817-292-5000
Mailing Address - Fax:817-292-5001
Practice Address - Street 1:6138 WALRAVEN CIR
Practice Address - Street 2:STE A&B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-2769
Practice Address - Country:US
Practice Address - Phone:817-292-5000
Practice Address - Fax:817-292-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00620TMedicare UPIN