Provider Demographics
NPI:1407015548
Name:JONATHAN ALVIOR MD LLC
Entity Type:Organization
Organization Name:JONATHAN ALVIOR MD LLC
Other - Org Name:ALVIOR MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PELAYO
Authorized Official - Last Name:ALVIOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-365-3525
Mailing Address - Street 1:1905 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7675
Mailing Address - Country:US
Mailing Address - Phone:813-365-3525
Mailing Address - Fax:813-365-3515
Practice Address - Street 1:1905 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7675
Practice Address - Country:US
Practice Address - Phone:813-365-3525
Practice Address - Fax:813-365-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG122XMedicare PIN