Provider Demographics
NPI:1730474735
Name:OLIVARES, JUAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:OLIVARES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 RICHMOND AVE APT 359
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3604
Mailing Address - Country:US
Mailing Address - Phone:214-280-9919
Mailing Address - Fax:
Practice Address - Street 1:5808 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4923
Practice Address - Country:US
Practice Address - Phone:713-695-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics