Provider Demographics
NPI:1861452500
Name:ALVINE, GREGORY FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:FRANKLIN
Last Name:ALVINE
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 1:2908 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4034
Mailing Address - Country:US
Mailing Address - Phone:605-336-2638
Mailing Address - Fax:605-334-3500
Practice Address - Street 1:810 E 23RD ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2135
Practice Address - Country:US
Practice Address - Phone:605-331-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4166207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0506345Medicaid
MN678520400Medicaid
SD6400930Medicaid
SD6400932Medicaid
SD6400932Medicaid
SDG23071Medicare UPIN
SD6400930Medicaid
MNS200003256Medicare PIN
SDS104515Medicare PIN