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General NPI Number Information
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NPI Number | 1265406334
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Entity Type | Individual
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Provider Name | DAVID A RIOS PA
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 808 BEACON ST
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City | WAYCROSS
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State | GA
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Zip | 31501-7104
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Country | US
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Telephone | 912-490-4325
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Fax | 912-490-7673
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Provider Business Mailing Address
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Address Line | 808 BEACON ST
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City | WAYCROSS
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State | GA
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Zip | 31501-7104
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Country | US
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Telephone | 912-490-4325
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Fax | 912-490-9673
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | PA06880
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA068880
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06880
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License Number State | TX
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