Healthcare Provider Details

I. General information

NPI: 1588711089
Provider Name (Legal Business Name): FRANK RIVAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 4TH AVE
HUNTINGTON WV
25701-2401
US

IV. Provider business mailing address

1302 4TH AVE P O BOX 9129
HUNTINGTON WV
25701-2401
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-3223
  • Fax: 304-522-2781
Mailing address:
  • Phone: 304-529-3223
  • Fax: 304-522-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number12133
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: