Provider Demographics
NPI:1053368332
Name:OLIVIERO, RAYMOND J (DPM)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:OLIVIERO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:137 WINDING MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070
Mailing Address - Country:US
Mailing Address - Phone:830-885-6163
Mailing Address - Fax:
Practice Address - Street 1:18838 STONE OAK PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4113
Practice Address - Country:US
Practice Address - Phone:210-496-3338
Practice Address - Fax:210-496-3349
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1766213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180589701Medicaid
TX6140640001Medicare NSC
TX612431Medicare PIN