Basic Information
| Provider Information | |||||||||
| NPI: | 1649376112 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUIS E ALVAREZ MD APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 ANDRE ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705632159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373649225 | ||||||||
| FaxNumber: | 3373646094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 ANDRE ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705632159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373649225 | ||||||||
| FaxNumber: | 3373646094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | ALVAREZ | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3373649225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 08364R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1982423 | 05 | LA | MEDICAID |