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General NPI Number Information
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NPI Number | 1639300395
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Entity Type | Organization
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Legal Business Name | ALVORD MEDICAL CONSULTANTS PS
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 2201 S 19TH ST STE 101
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City | TACOMA
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State | WA
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Zip | 98405-2961
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Country | US
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Telephone | 252-222-2172
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 S 19TH ST STE 101
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City | TACOMA
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State | WA
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Zip | 98405-2961
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Country | US
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Telephone | 252-222-2172
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REX MARTIN ALVORD JR.
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Credential | MD
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Telephone | 253-222-2172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 00035185
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License Number State | WA
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