Provider Demographics
NPI:1215997259
Name:ALVAREZ, ELIAZAR G (MD)
Entity type:Individual
Prefix:
First Name:ELIAZAR
Middle Name:G
Last Name:ALVAREZ
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 1:4400 OAK PARK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-9534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3920 W WHEATLAND RD STE 152
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3404
Practice Address - Country:US
Practice Address - Phone:214-467-0432
Practice Address - Fax:214-467-0635
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9983207Q00000X
CAG67483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674830Medicaid
TX186417502Medicaid
TX168068805Medicaid
TX186417501Medicaid
TXTXB110778Medicare PIN
TX8J3385Medicare PIN
TX168068805Medicaid