Healthcare Provider Details

I. General information

NPI: 1275534984
Provider Name (Legal Business Name): EUGENE ALBERT RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR # 504E
MIAMI FL
33176-2148
US

IV. Provider business mailing address

8940 N KENDALL DR # 504E
MIAMI FL
33176-2148
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-6200
  • Fax: 786-533-1680
Mailing address:
  • Phone: 305-595-6200
  • Fax: 786-533-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME50085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: