Organization
OLIVIARAE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WILSON (ADMINISTRATOR)
(409) 673-4139
Entity
Organization
Contact information
Practice address
16 COTTAGE GROVE CT, BEAUMONT, TX 77713-5100
(512) 203-5904
Mailing address
PO BOX 7072, BEAUMONT, TX 77726-7072
(512) 203-5904
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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