Provider Demographics
NPI:1417078031
Name:ALVAREZ, RICARDO BANJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:BANJAMIN
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 1:1013 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8744
Mailing Address - Country:US
Mailing Address - Phone:706-507-7067
Mailing Address - Fax:706-221-3179
Practice Address - Street 1:1013 TALBOTTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8744
Practice Address - Country:US
Practice Address - Phone:706-507-7067
Practice Address - Fax:706-221-3179
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052876207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA518280047CMedicaid
GA518280047CMedicaid