Provider Demographics
NPI:1447254891
Name:ALVEZ, LAURA D (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:ALVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:736 ROUTE 4
Mailing Address - Street 2:STE. 103
Mailing Address - City:SINAJANA
Mailing Address - State:GUAM
Mailing Address - Zip Code:96910
Mailing Address - Country:UM
Mailing Address - Phone:671-649-7232
Mailing Address - Fax:671-649-7232
Practice Address - Street 1:736 ROUTE 4
Practice Address - Street 2:STE. 103
Practice Address - City:SINAJANA
Practice Address - State:GUAM
Practice Address - Zip Code:96910
Practice Address - Country:UM
Practice Address - Phone:671-649-7232
Practice Address - Fax:671-649-7232
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV18145207RN0300X
OH35069336A207RN0300X
PAMD050934L207RN0300X
GUM-1632207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000776471OtherBLUE CROSS BLUE SHIELD
GUM-1632OtherMEDICAL LICENSE
PA000776471OtherBLUE CROSS BLUE SHIELD
WVA18145BOtherHEALTH PLAN OF UPPER OHIO
OH0181860Medicaid
WV0078188000Medicaid
WV84134OtherCOVENTRY/CARELINK
OH000776471OtherBLUE CROSS BLUE SHIELD
WV390008192Medicare PIN
GUCR305ZMedicare UPIN
GUM-1632OtherMEDICAL LICENSE
PA000776471OtherBLUE CROSS BLUE SHIELD
OH0181860Medicaid
WV000776471OtherBLUE CROSS BLUE SHIELD
WVAL0855403Medicare PIN