MEDICARE: BRIAN R RIVELAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35.052781	OH
2	207R00000X	Internal Medicine Physician	DR.0069828	CO
3	207R00000X	Internal Medicine Physician	MD-23143	HI
4	207R00000X	Internal Medicine Physician	MD213420	OR
5	207R00000X	Internal Medicine Physician	036.157488	IL
6	207R00000X	Internal Medicine Physician	17030	AZ
7	207R00000X	Internal Medicine Physician	ME148147	FL
8	207R00000X	Internal Medicine Physician	AM00196	TX

General Provider Information

NPI Number	:	1093715658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN R RIVELAND M.D.

Provider Business Mailing Address
First Line	:	27820 N 15TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5373
Country	:	US
Telephone Number	:	602-697-7527
Fax Number	:	480-336-8349

Provider Business Practice Location Address
First Line	:	27820 N 15TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5373
Country	:	US
Telephone Number	:	602-697-7527
Fax Number	:	480-336-8349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/10/2023

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Directions to “ BRIAN R RIVELAND M.D.” Practice Location

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