Healthcare Provider Details

I. General information

NPI: 1578547626
Provider Name (Legal Business Name): JOSE ALVAREZ-VILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER DR
ADA OK
74820-3439
US

IV. Provider business mailing address

1921 STONECIPHER DR
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-3980
  • Fax: 580-421-6283
Mailing address:
  • Phone: 580-436-3980
  • Fax: 580-421-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number09244
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number24747
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: