MEDICARE: DR. ALEX GUEVARA JR. D.O.

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	207Q00000X	Family Medicine Physician	H0411	TX

General Provider Information

NPI Number	:	1699768481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX GUEVARA JR. D.O.

Provider Business Mailing Address
First Line	:	1217 GRAND AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-9041
Country	:	US
Telephone Number	:	817-625-7733
Fax Number	:	817-740-1602

Provider Business Practice Location Address
First Line	:	1217 GRAND AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-9041
Country	:	US
Telephone Number	:	817-625-7733
Fax Number	:	817-740-1602

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2010

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