Provider Demographics
NPI:1154447993
Name:ALVAREZ-PAIVA, GUSTAVO ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ALEJANDRO
Last Name:ALVAREZ-PAIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:
Practice Address - Street 1:1800 PLAZA DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6013
Practice Address - Country:US
Practice Address - Phone:817-310-4490
Practice Address - Fax:817-310-4491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43780207ZP0101X
MO2003024385207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001765Medicare PIN