Provider Demographics
NPI:1801072541
Name:ALVARADO, GILBERT (PA-C)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N AVENUE F
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-2741
Mailing Address - Country:US
Mailing Address - Phone:806-592-9501
Mailing Address - Fax:806-592-3052
Practice Address - Street 1:415 N AVENUE F
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2741
Practice Address - Country:US
Practice Address - Phone:806-592-9501
Practice Address - Fax:806-592-3052
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05491363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0075DJOtherBLUE CROSS/BLUE SHIELD
TX137227810Medicaid
TX063623501Medicaid
TX0082EVOtherBLUE CROSS/BLUE SHIELD
TX0082EVOtherBLUE CROSS/BLUE SHIELD
458811Medicare PIN