Healthcare Provider Details

I. General information

NPI: 1972899144
Provider Name (Legal Business Name): DENNIS RIVERO, MD, INC., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 06/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S 36TH ST
MUSKOGEE OK
74401-5043
US

IV. Provider business mailing address

209 S 36TH ST
MUSKOGEE OK
74401-5043
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-7717
  • Fax: 918-682-9434
Mailing address:
  • Phone: 918-682-7717
  • Fax: 918-682-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25366
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number25366
License Number StateOK

VIII. Authorized Official

Name: DR. DENNIS PALMER RIVERO
Title or Position: OWNER
Credential: M.D.
Phone: 918-682-7717