Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD00035185 | WA |
NPI | 1104958693 |
---|---|
Provider Name | Dr. Rex Martin Alvord JR. |
First Address | Tacoma, WA 98403-3012 |
Second Address | Tacoma, WA 98405-2962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2007 |
Last Update Date | 08/07/2007 |