Provider Demographics
NPI:1760445167
Name:ALVAREZ, JAIME ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ALBERTO
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 1:12140 CARISSA COMMERCE CT STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-5313
Mailing Address - Country:US
Mailing Address - Phone:239-895-0900
Mailing Address - Fax:833-659-2185
Practice Address - Street 1:12140 CARISSA COMMERCE CT STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-5313
Practice Address - Country:US
Practice Address - Phone:239-895-0900
Practice Address - Fax:833-659-2185
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77655207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46245OtherBCBS
FL2565919-00Medicaid
FL1290460001Medicare NSC
FL46245ZMedicare PIN