Healthcare Provider Details

I. General information

NPI: 1770511024
Provider Name (Legal Business Name): EVER I RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 BELL SHOALS RD
BRANDON FL
33511-8813
US

IV. Provider business mailing address

1114 BELL SHOALS RD
BRANDON FL
33511-8813
US

V. Phone/Fax

Practice location:
  • Phone: 813-940-8140
  • Fax: 813-940-8148
Mailing address:
  • Phone: 813-940-8140
  • Fax: 813-940-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: