Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | K7645 | TX |
NPI | 1124071667 |
---|---|
Provider Name | Jeffrey Joel Alvis |
First Address | Mckinney, TX 75070-5102 |
Second Address | Mckinney, TX 75070-5102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8K8380 | BLUE CROSS & BLUE SHIELD (01) | TX |
H40755 | (02) | TX |