MEDICARE: BRICK EDUARDO ALVA 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	207RG0100X	Gastroenterology Physician	M3140	TX

General Provider Information

NPI Number	:	1720025380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRICK EDUARDO ALVA M.D.

Provider Business Mailing Address
First Line	:	11738 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3514
Country	:	US
Telephone Number	:	713-494-1805
Fax Number	:

Provider Business Practice Location Address
First Line	:	11738 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3514
Country	:	US
Telephone Number	:	713-494-1805
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/28/2011

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