Provider Demographics
NPI:1093899379
Name:ALVAREZ, JOSE HIRAM (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:HIRAM
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:H
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3003 HIGHWAY 95
Mailing Address - Street 2:SUITE 39
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429
Mailing Address - Country:US
Mailing Address - Phone:928-758-1010
Mailing Address - Fax:928-758-1428
Practice Address - Street 1:3003 HIGHWAY 95
Practice Address - Street 2:SUITE 39
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86429
Practice Address - Country:US
Practice Address - Phone:928-758-1010
Practice Address - Fax:928-758-1428
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD21702174400000X
AZ21702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145525Medicaid
AZ145525Medicaid
AZF67902Medicare UPIN