Healthcare Provider Details

I. General information

NPI: 1932192929
Provider Name (Legal Business Name): JULIO R RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17521 ST LUKES WAY STE 110
THE WOODLANDS TX
77384-8041
US

IV. Provider business mailing address

17521 ST LUKES WAY STE 110
THE WOODLANDS TX
77384-8041
US

V. Phone/Fax

Practice location:
  • Phone: 936-266-2255
  • Fax: 936-447-9474
Mailing address:
  • Phone: 936-266-2255
  • Fax: 936-447-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002-0378
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN1859
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN1859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: