Provider Demographics
NPI:1417330028
Name:AJAERO, OLIVIA (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:AJAERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 SOUTH FWY STE 140
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8435
Mailing Address - Country:US
Mailing Address - Phone:817-295-7214
Mailing Address - Fax:817-295-7062
Practice Address - Street 1:12608 SOUTH FWY STE 140
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8435
Practice Address - Country:US
Practice Address - Phone:817-295-7214
Practice Address - Fax:817-295-7062
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU3271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine