Individual
ESIQUIEL P OLIVAREZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6138 WALRAVEN CIR STE A&B, FORT WORTH, TX 76133-2769
(817) 292-5000
(817) 292-5001
Mailing address
6138 WALRAVEN CIR STE A&B, FORT WORTH, TX 76133-2769
(817) 292-5000
(817) 292-5001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L1684
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151562901
—
TX
05
—
151562903
—
TX
Enumeration date
08/08/2006
Last updated
03/26/2014
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