1811054489 NPI number — DR. JULIE M ALVAREZ MD

Table of content: DR. JULIE M ALVAREZ MD (NPI 1811054489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811054489 NPI number — DR. JULIE M ALVAREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVAREZ
Provider First Name:
JULIE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALVAREZ GOMEZ
Provider Other First Name:
JULIE
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811054489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6412 CHARLOTTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66216-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-631-2720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6675 HOLMES RD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-6609
Provider Business Practice Location Address Fax Number:
816-523-6616
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R1E77 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 0419957 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 64131A002 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202124012 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10534021 . This is a "BLUE CROSS BLUE SHIELD OF" identifier . This identifiers is of the category "OTHER".




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