Healthcare Provider Details

I. General information

NPI: 1467930891
Provider Name (Legal Business Name): JORGE LUIS ALVES MEDICO CIRUJANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 DR PHILLIPS BLVD STE 7
ORLANDO FL
32819-5140
US

IV. Provider business mailing address

11513 LAKE UNDERHILL RD
ORLANDO FL
32825-5001
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax: 407-249-1755
Mailing address:
  • Phone: 407-249-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14864-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME149151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: