Provider Demographics
NPI:1114521267
Name:SMITH, ALVIN JAMES
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 W WASHINGTON ST APT 1064
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0927
Mailing Address - Country:US
Mailing Address - Phone:202-907-9344
Mailing Address - Fax:
Practice Address - Street 1:1003 W WASHINGTON ST APT 1064
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-0927
Practice Address - Country:US
Practice Address - Phone:202-907-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No175T00000XOther Service ProvidersPeer Specialist