Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 105212 | MO |
NPI | 1003920836 |
---|---|
Provider Name | Dr. Jose I Alvarez |
First Address | Belleville, IL 62221-7609 |
Second Address | Saint Louis, MO 63139-3215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H76506 | (02) |