Provider Demographics
NPI:1093752206
Name:OLIVARES, RAFAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:J
Last Name:OLIVARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 BLVD # 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:355 UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1500
Practice Address - Country:US
Practice Address - Phone:303-603-9930
Practice Address - Fax:303-403-6242
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO40125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37127527Medicaid
COCOA109125Medicare PIN