MEDICARE: JORGE LUIS ALVAREZ SR. 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	208D00000X	General Practice Physician	17,202	PR

General Provider Information

NPI Number	:	1558525899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS ALVAREZ SR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 169
Second Line	:
City	:	ARROYO
State	:	PR
Zip	:	00714-0169
Country	:	US
Telephone Number	:	702-218-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 ABRAMS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5795
Country	:	US
Telephone Number	:	702-218-8008
Fax Number	:

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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