Provider Demographics
NPI:1881605780
Name:OLIVIERI, JULIO CESAR JR (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CESAR
Last Name:OLIVIERI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4512 RALPH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-1845
Mailing Address - Country:US
Mailing Address - Phone:972-243-7903
Mailing Address - Fax:972-243-7905
Practice Address - Street 1:4512 RALPH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1845
Practice Address - Country:US
Practice Address - Phone:972-243-7903
Practice Address - Fax:972-243-7905
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10028091OtherAMERIGROUP IDENTIFICATION
TX111912503Medicaid
TX4785OtherPARKLAND IDENTIFICATION #
TX111912501Medicaid
TX0057BLOtherBLUECROSS BLUE SHIELD
TX0057BLMedicare ID - Type UnspecifiedIDENTIFICATION NUMBER
TX4785OtherPARKLAND IDENTIFICATION #
TXTXB140076Medicare PIN