MEDICARE: DR. JUAN M ALVAREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R7H86	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00035720	OTHER	MO	RAILRAOD MEDICARE

General Provider Information

NPI Number	:	1356315634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN M ALVAREZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-4369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 SHACKELFORD RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-4369
Country	:	US
Telephone Number	:	314-921-4420
Fax Number	:	314-921-6086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/19/2020

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