Provider Demographics
NPI:1548313950
Name:ALVAREZ-BERNAL, JOSE E (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:ALVAREZ-BERNAL
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 1:6408 N ARMENIA AVE STE B-1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5770
Mailing Address - Country:US
Mailing Address - Phone:813-352-8305
Mailing Address - Fax:813-666-0509
Practice Address - Street 1:6408 N ARMENIA AVE STE B-1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5770
Practice Address - Country:US
Practice Address - Phone:813-352-8305
Practice Address - Fax:813-666-0509
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38971207RA0401X
FLME0038971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067247500Medicaid
FL067247500Medicaid
FLD85532Medicare UPIN