Healthcare Provider Details

I. General information

NPI: 1194801993
Provider Name (Legal Business Name): GARY S. RIVARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MAIN ST
TURNER ME
04282-4138
US

IV. Provider business mailing address

180 CHURCH HILL RD STE 1
LEEDS ME
04263-3418
US

V. Phone/Fax

Practice location:
  • Phone: 207-524-3501
  • Fax: 207-225-2692
Mailing address:
  • Phone: 207-524-3501
  • Fax: 207-524-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2113
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: