Provider Demographics
NPI:1730392739
Name:OLIVARES, ROBERT A JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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:PO BOX 203629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0001
Mailing Address - Country:US
Mailing Address - Phone:915-533-3474
Mailing Address - Fax:915-544-5037
Practice Address - Street 1:1801 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3524
Practice Address - Country:US
Practice Address - Phone:915-521-1200
Practice Address - Fax:866-862-5432
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6323207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190619002Medicaid
TX190619001Medicaid
NM52589871Medicaid
TXP00465438OtherRR MEDICARE
NM52589871Medicaid