MEDICARE: JULIO R OLAYA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	E4104	AR
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	2013001194	MO
3	208VP0000X	Pain Medicine Physician	2013001194	MO
4	208VP0000X	Pain Medicine Physician	E4104	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285724757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIO R OLAYA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9178
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811-9178
Country	:	US
Telephone Number	:	800-824-4094
Fax Number	:	479-968-1673

Provider Business Practice Location Address
First Line	:	1225 BRECKENRIDGE DR STE 106
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1565
Country	:	US
Telephone Number	:	501-451-2500
Fax Number	:	479-968-1673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	06/27/2022

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