Provider Demographics
NPI:1184677981
Name:ALVARADO, LAWRENCE A III (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:ALVARADO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:A
Other - Last Name:ALVARADO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3133 SUMMER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8255
Mailing Address - Country:US
Mailing Address - Phone:509-910-0569
Mailing Address - Fax:
Practice Address - Street 1:925 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6900
Practice Address - Country:US
Practice Address - Phone:406-599-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046400207L00000X, 207LP2900X
MTMED-PHYS-LIC-44405207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8455313Medicaid
WAI53471Medicare UPIN
G8861718Medicare PIN