MEDICARE: DR. WILLIAM JOEL RIVERA CARRERO MD

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	208D00000X	General Practice Physician	1783	FL

General Provider Information

NPI Number	:	1104669506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JOEL RIVERA CARRERO MD

Provider Business Mailing Address
First Line	:	1210 E OSCEOLA PKWY STE 201
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-1621
Country	:	US
Telephone Number	:	321-422-2303
Fax Number	:	855-538-4617

Provider Business Practice Location Address
First Line	:	1210 E OSCEOLA PKWY STE 201
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-1621
Country	:	US
Telephone Number	:	321-422-2303
Fax Number	:	855-538-4617

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	04/08/2026

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