Provider Demographics
NPI:1285724757
Name:OLAYA, JULIO R (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:R
Last Name:OLAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:800-824-4094
Mailing Address - Fax:479-968-1673
Practice Address - Street 1:1225 BRECKENRIDGE DR STE 106
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1565
Practice Address - Country:US
Practice Address - Phone:501-451-2500
Practice Address - Fax:479-968-1673
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE4104207L00000X, 208VP0000X
MO2013001194207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156129001Medicaid
AR156129001Medicaid
I07827Medicare UPIN