MEDICARE: DR. ALFRED H RIVERA 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	207W00000X	Ophthalmology Physician	ME44196	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689609653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED H RIVERA MD

Provider Business Mailing Address
First Line	:	PO BOX 566120
Second Line	:
City	:	PINECREST
State	:	FL
Zip	:	33256-6120
Country	:	US
Telephone Number	:	305-666-2365
Fax Number	:	305-279-3988

Provider Business Practice Location Address
First Line	:	10260 SW 56TH ST
Second Line	:	SUITE 104
City	:	MIAMI
State	:	FL
Zip	:	33165-7001
Country	:	US
Telephone Number	:	305-666-2365
Fax Number	:	305-595-6352

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/04/2013

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