Healthcare Provider Details

I. General information

NPI: 1982670758
Provider Name (Legal Business Name): ERIK C RIVERS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 MARKET PTE DR STE 100
BLOOMINGTON MN
55435-5435
US

IV. Provider business mailing address

4300 MARKET PTE DR STE 100
BLOOMINGTON MN
55435-5435
US

V. Phone/Fax

Practice location:
  • Phone: 952-767-4574
  • Fax: 952-835-4403
Mailing address:
  • Phone: 952-767-4574
  • Fax: 952-835-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9272
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: