Provider Demographics
NPI:1164745972
Name:SOUTH PENINSULA GENERAL SURGERY LLC
Entity Type:Organization
Organization Name:SOUTH PENINSULA GENERAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-235-1010
Mailing Address - Street 1:PO BOX 3287
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-3287
Mailing Address - Country:US
Mailing Address - Phone:907-235-1010
Mailing Address - Fax:907-235-1099
Practice Address - Street 1:104 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7546
Practice Address - Country:US
Practice Address - Phone:907-235-1010
Practice Address - Fax:907-235-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty