Provider Demographics
NPI:1467930891
Name:ALVES, JORGE LUIS (MEDICO CIRUJANO)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:ALVES
Suffix:
Gender:M
Credentials:MEDICO CIRUJANO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11513 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5001
Mailing Address - Country:US
Mailing Address - Phone:407-249-1234
Mailing Address - Fax:
Practice Address - Street 1:7051 DR PHILLIPS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5140
Practice Address - Country:US
Practice Address - Phone:407-249-1234
Practice Address - Fax:407-249-1755
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14864-I208000000X
FLME149151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110476500Medicaid