Healthcare Provider Details

I. General information

NPI: 1235766502
Provider Name (Legal Business Name): EVAN RIVERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 AMBASSADOR CAFFERY PKWY STE 420
LAFAYETTE LA
70508-8802
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-6498
  • Fax: 337-470-6517
Mailing address:
  • Phone: 337-470-6498
  • Fax: 225-765-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number322829
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number344550
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: