Provider Demographics
NPI:1629057476
Name:JUAN J ALVA MD PA
Entity Type:Organization
Organization Name:JUAN J ALVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ALVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:919-688-4748
Mailing Address - Street 1:609 WILLIAM VICKERS AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3140
Mailing Address - Country:US
Mailing Address - Phone:919-688-4748
Mailing Address - Fax:919-682-1133
Practice Address - Street 1:609 WILLIAM VICKERS AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3140
Practice Address - Country:US
Practice Address - Phone:919-688-4748
Practice Address - Fax:919-682-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21591OtherSTATE LICENSE
NC202592OtherMDR FOR LAB
NC8910986Medicaid
NC10986OtherBCBS
NC21591OtherSTATE LICENSE
NC8910986Medicaid