Provider Demographics
NPI:1184612376
Name:GUEVARA, ALFREDO JR (MD FACS)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:GUEVARA
Suffix:JR
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2060
Mailing Address - Country:US
Mailing Address - Phone:520-761-3103
Mailing Address - Fax:520-287-4862
Practice Address - Street 1:507 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2060
Practice Address - Country:US
Practice Address - Phone:520-761-3103
Practice Address - Fax:520-287-4862
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11435208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203216Medicaid
AZ203216Medicaid
C99585Medicare UPIN