MEDICARE: DR. MELQUIADES OLIVARES JR. 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	208D00000X	General Practice Physician	90265	NM

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	:	1629084272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELQUIADES OLIVARES JR. M.D,

Provider Business Mailing Address
First Line	:	260 MILLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4125
Country	:	US
Telephone Number	:	505-425-6731
Fax Number	:	505-454-9193

Provider Business Practice Location Address
First Line	:	260 MILLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4125
Country	:	US
Telephone Number	:	505-425-6731
Fax Number	:	505-454-9193

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	06/18/2010

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