MEDICARE: JOSE J RIVERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	35429	KY
2	208VP0014X	Interventional Pain Medicine Physician	35429	KY
3	208VP0014X	Interventional Pain Medicine Physician	ME103262	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215919485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE J RIVERA M.D.

Provider Business Mailing Address
First Line	:	2333 W HILLSBOROUGH AVE STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1059
Country	:	US
Telephone Number	:	813-872-4492
Fax Number	:	813-870-1502

Provider Business Practice Location Address
First Line	:	2333 W HILLSBOROUGH AVE STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1059
Country	:	US
Telephone Number	:	813-872-4492
Fax Number	:	813-870-1502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/27/2019

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