MEDICARE: DR. IVAN A RIVERA SOLER MD

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	208D00000X	General Practice Physician	ACN241	FL
2	208D00000X	General Practice Physician	14883	PR

General Provider Information

NPI Number	:	1245433861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN A RIVERA SOLER MD

Provider Business Mailing Address
First Line	:	51 N DOVERPLUM AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-3308
Country	:	US
Telephone Number	:	407-572-8862
Fax Number	:	407-572-8863

Provider Business Practice Location Address
First Line	:	51 N DOVERPLUM AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-3308
Country	:	US
Telephone Number	:	407-572-8862
Fax Number	:	407-572-8863

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

Provider Enumeration Date	:	06/10/2007
Last Update Date	:	02/15/2017

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