Provider Demographics
NPI:1609837285
Name:ALVAREZ, PRAXEDES EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAXEDES
Middle Name:EDUARDO
Last Name:ALVAREZ
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:PO BOX 331124
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1124
Mailing Address - Country:US
Mailing Address - Phone:787-842-2802
Mailing Address - Fax:
Practice Address - Street 1:2916 EMILIO FAGOT
Practice Address - Street 2:SUITE 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3611
Practice Address - Country:US
Practice Address - Phone:787-842-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8015207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-82073Medicare UPIN
PR80346Medicare ID - Type Unspecified