=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235766502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN RIVERE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2020
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4809 AMBASSADOR CAFFERY PKWY STE 420
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-8802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-470-6498
-----------------------------------------------------
Fax | 337-470-6517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5959 S SHERWOOD FOREST BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-6038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-470-6498
-----------------------------------------------------
Fax | 225-765-6916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 322829
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 344550
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------