Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN012666 | GA |
NPI | 1073632659 |
---|---|
Provider Name | Dr. Fernando Alvarado |
First Address | Valdosta, GA 31605-1042 |
Second Address | Valdosta, GA 31605-1042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 17/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
509010518A | (05) | GA |