Provider Demographics
NPI:1174624084
Name:OLAY, HONORATO P JR (MD)
Entity type:Individual
Prefix:DR
First Name:HONORATO
Middle Name:P
Last Name:OLAY
Suffix:JR
Gender:M
Credentials:MD
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 1030
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-1030
Mailing Address - Country:US
Mailing Address - Phone:940-937-3636
Mailing Address - Fax:940-937-9644
Practice Address - Street 1:1001 HWY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201
Practice Address - Country:US
Practice Address - Phone:940-937-3636
Practice Address - Fax:940-937-9644
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88M022OtherBLUE CROSS BLUE SHIELD
TX125032603Medicaid
TX88M022OtherBLUE CROSS BLUE SHIELD
TX88M022Medicare PIN