1619202314 NPI number — G. ALVAREZ, MD, P.A.

Table of content: (NPI 1619202314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619202314 NPI number — G. ALVAREZ, MD, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G. ALVAREZ, MD, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619202314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 MEDICAL CARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-5937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-510-1296
Provider Business Mailing Address Fax Number:
877-260-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 MEDICAL CARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-510-1296
Provider Business Practice Location Address Fax Number:
877-260-8175
Provider Enumeration Date:
10/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALVAREZ
Authorized Official First Name:
GERMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
404-510-1296

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME 104905 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001275300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013710300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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