Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 30896 | IA |
NPI | 1003957903 |
---|---|
Provider Name | Jorge L Alvarez |
First Address | Jacksonville, FL 32207-8568 |
Second Address | Jacksonville, FL 32207-8568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 16/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1133421 | (05) | IA |
47245 | BLUE CROSS BLUE SHIELD (01) | IA |
F26169 | (02) |