Healthcare Provider Details

I. General information

NPI: 1699763656
Provider Name (Legal Business Name): AGUSTIN E RIOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EASTMAN AVE
BEDFORD NH
03110-6701
US

IV. Provider business mailing address

21 EASTMAN AVE
BEDFORD NH
03110-6701
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-5772
  • Fax: 603-625-9889
Mailing address:
  • Phone: 603-625-5772
  • Fax: 603-625-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0271
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: