Provider Demographics
NPI:1083705453
Name:ALVAREZ, FRANK SEVERIANO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:SEVERIANO
Last Name:ALVAREZ
Suffix:JR
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 1:1040 MASON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-248-0107
Mailing Address - Fax:386-248-0109
Practice Address - Street 1:697 MAITLAND AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6821
Practice Address - Country:US
Practice Address - Phone:407-539-2111
Practice Address - Fax:407-539-1211
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62112Medicare ID - Type Unspecified
FLD57293Medicare UPIN