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General NPI Number Information
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NPI Number | 1386789410
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Entity Type | Individual
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Provider Name | JOHN JEFFREY ALVITRE PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2 1 CAVALRY 4 2 ID 3RD DIVISION DRIVE
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City | TACOMA
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State | WA
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Zip | 98433
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Country | US
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Telephone | 253-966-4098
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Fax | 253-966-4098
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Provider Business Mailing Address
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Address Line | 1617 KINCAID ST
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City | DUPONT
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State | WA
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Zip | 98327-9789
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Country | US
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Telephone | 253-583-4656
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Fax | 253-964-2315
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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