Provider Demographics
NPI:1477930501
Name:ALVAREZ GALBAN, EDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDEL
Middle Name:
Last Name:ALVAREZ GALBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 18TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1731
Mailing Address - Country:US
Mailing Address - Phone:813-453-7931
Mailing Address - Fax:
Practice Address - Street 1:2878 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-1923
Practice Address - Country:US
Practice Address - Phone:727-474-3442
Practice Address - Fax:727-474-3648
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN652208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015831700Medicaid