Provider Demographics
NPI:1689649436
Name:CORCHADO, OLIVERIO (PA-C)
Entity type:Individual
Prefix:MR
First Name:OLIVERIO
Middle Name:
Last Name:CORCHADO
Suffix:
Gender:M
Credentials:PA-C
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 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-626-0600
Mailing Address - Fax:210-626-1174
Practice Address - Street 1:19780 S US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-9761
Practice Address - Country:US
Practice Address - Phone:210-626-0600
Practice Address - Fax:210-626-1174
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0990Medicare ID - Type Unspecified
TXS90667Medicare UPIN