Provider Demographics
NPI:1881690055
Name:ECHEVARRIA-VARGAS, ALEXIS MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MIGUEL
Last Name:ECHEVARRIA-VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-0495
Mailing Address - Country:US
Mailing Address - Phone:765-674-3321
Mailing Address - Fax:254-286-7217
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:254-286-7217
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7874208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD95884Medicare UPIN
PR0081133Medicare PIN