=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467577833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROLANDO ALVAREZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 11/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1054 GATEWAY BLVD STE 103
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-8315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-847-4654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1054 GATEWAY BLVD STE 103
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-8315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-847-4654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207U00000X
-----------------------------------------------------
Taxonomy Name | Nuclear Medicine Physician
-----------------------------------------------------
License Number | 4301086393
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207UN0901X
-----------------------------------------------------
Taxonomy Name | Nuclear Cardiology Physician
-----------------------------------------------------
License Number | 4301086393
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207UN0901X
-----------------------------------------------------
Taxonomy Name | Nuclear Cardiology Physician
-----------------------------------------------------
License Number | ME 99777
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207UN0902X
-----------------------------------------------------
Taxonomy Name | Nuclear Imaging & Therapy Physician
-----------------------------------------------------
License Number | 4301086393
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207UN0902X
-----------------------------------------------------
Taxonomy Name | Nuclear Imaging & Therapy Physician
-----------------------------------------------------
License Number | ME 99777
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207UN0903X
-----------------------------------------------------
Taxonomy Name | In Vivo & In Vitro Nuclear Medicine Physician
-----------------------------------------------------
License Number | 4301086393
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 207UN0903X
-----------------------------------------------------
Taxonomy Name | In Vivo & In Vitro Nuclear Medicine Physician
-----------------------------------------------------
License Number | ME 99777
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 207U00000X
-----------------------------------------------------
Taxonomy Name | Nuclear Medicine Physician
-----------------------------------------------------
License Number | ME 99777
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------