Provider Demographics
NPI:1013973874
Name:OLAECHEA, REYNALDO A (MD)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:A
Last Name:OLAECHEA
Suffix:
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 1:421 S MAIN ST # 231
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5048
Mailing Address - Country:US
Mailing Address - Phone:931-459-7012
Mailing Address - Fax:931-210-5704
Practice Address - Street 1:124 HAYES ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-787-1620
Practice Address - Fax:931-787-1622
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7369208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020038845OtherMEDICARE RAILROAD
020038845OtherMEDICARE RAILROAD
B59243Medicare UPIN
TN31535161Medicaid