Provider Demographics
NPI:1144326257
Name:OLVERA, REBECCA E (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:OLVERA
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:5708 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4115
Practice Address - Country:US
Practice Address - Phone:817-336-4040
Practice Address - Fax:817-336-6780
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK56472080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1004989OtherCIGNA PIN
TX140442852Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX139778100OtherFIRSTCARE PIN
1750369203OtherGRP NPI NUMBER
TX810600278OtherPHCS PIN
TX2158312OtherFIRSTHEALTH PIN
TX8F0034OtherBCBSTX IND PIN
TX7045492OtherAETNA PIN
TX10010816OtherAMERIGROUP PIN
TX124175OtherSUPERIOR PIN
TX137345810Medicaid
TX158081304Medicaid
TX2362024OtherUHC PIN
TX137345810Medicaid
TX158081304Medicaid
TX8B9673Medicare PIN