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General NPI Number Information
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NPI Number | 1164745972
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Entity Type | Organization
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Legal Business Name | SOUTH PENINSULA GENERAL SURGERY LLC
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 104 E FAIRVIEW AVE
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City | HOMER
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State | AK
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Zip | 99603-7546
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Country | US
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Telephone | 907-235-1010
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Fax | 907-235-1099
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Provider Business Mailing Address
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Address Line | PO BOX 3287
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City | HOMER
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State | AK
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Zip | 99603-3287
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Country | US
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Telephone | 907-235-1010
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Fax | 907-235-1099
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENE L ALVAREZ
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Credential | MD
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Telephone | 907-235-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2272
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License Number State | AK
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