Provider Demographics
NPI:1447562541
Name:JULIO OLIVIERI
Entity Type:Organization
Organization Name:JULIO OLIVIERI
Other - Org Name:URBAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-381-1910
Mailing Address - Street 1:6300 SAMUELL BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7137
Mailing Address - Country:US
Mailing Address - Phone:214-381-1910
Mailing Address - Fax:214-381-2868
Practice Address - Street 1:6300 SAMUELL BLVD
Practice Address - Street 2:STE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7137
Practice Address - Country:US
Practice Address - Phone:214-381-1910
Practice Address - Fax:214-381-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10028091OtherAMERIGROUP IDENTIFICATION
TX111912503Medicaid
TX4785OtherPARKLAND IDENTIFICATION
TX0057BLOtherBLUECROSS BLUE SHIELD
TX111912501Medicaid
TX111912501Medicaid
TX111912503Medicaid