Provider Demographics
NPI:1710996442
Name:ALVARADO, LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1101 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3735
Mailing Address - Country:US
Mailing Address - Phone:316-788-6963
Mailing Address - Fax:316-788-5373
Practice Address - Street 1:1101 N ROCK RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037
Practice Address - Country:US
Practice Address - Phone:316-788-6963
Practice Address - Fax:316-788-5373
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS080145154OtherMEDICARE RAILRAOD
KS057434OtherBC/BS
KSG47804Medicare UPIN