Provider Demographics
NPI:1427018688
Name:ALVAREZ, EDGAR RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:RENE
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP CHFM
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3196
Practice Address - Fax:904-244-8005
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME63758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2521946-00Medicaid
GA000762044BMedicaid
FLF86104Medicare UPIN
FL80109603Medicare PIN
FL2521946-00Medicaid
GA000762044BMedicaid