Provider Demographics
NPI:1053365692
Name:ALVAREZ, RAUL A (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 NW 77TH CT STE 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1537
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:786-618-5307
Practice Address - Street 1:1272 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-687-1817
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME51139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008612400Medicaid
FL0461075Medicaid
FL00004276Medicare ID - Type Unspecified