Provider Demographics
NPI:1699768481
Name:GUEVARA, ALEX JR (DO)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:GUEVARA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-9041
Mailing Address - Country:US
Mailing Address - Phone:817-625-7733
Mailing Address - Fax:817-740-1602
Practice Address - Street 1:1217 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-9041
Practice Address - Country:US
Practice Address - Phone:817-625-7733
Practice Address - Fax:817-740-1602
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH0411Medicare UPIN
TX8A9698Medicare ID - Type Unspecified