Provider Demographics
NPI:1811906795
Name:ALVERSON, EDWARD DON (PA-C)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DON
Last Name:ALVERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:EDDIE
Other - Middle Name:DON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 CALVIN DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-1405
Mailing Address - Country:US
Mailing Address - Phone:254-773-3843
Mailing Address - Fax:
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-0736
Practice Address - Fax:254-743-0423
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1009061363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10090061OtherNCCPA NUMBER