Healthcare Provider Details

I. General information

NPI: 1740417211
Provider Name (Legal Business Name): MATTHEW B RIVARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIVISION OF NEPHROLOGY UNIV OF WASHINGTON 1959 NE PACIFIC STREET, BOX 356521
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

DIVISION OF NEPHROLOGY UNIV OF WASHINGTON 1959 NE PACIFIC STREET, BOX 356521
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-2346
  • Fax:
Mailing address:
  • Phone: 206-543-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60280247
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number60280247
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: