MEDICARE: EVER I RIVERA 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	208000000X	Pediatrics Physician	ME88369	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53755	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770511024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVER I RIVERA MD

Provider Business Mailing Address
First Line	:	1114 BELL SHOALS RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-8813
Country	:	US
Telephone Number	:	813-940-8140
Fax Number	:	813-940-8148

Provider Business Practice Location Address
First Line	:	1114 BELL SHOALS RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-8813
Country	:	US
Telephone Number	:	813-940-8140
Fax Number	:	813-940-8148

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/12/2020

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Directions to “ EVER I RIVERA MD” Practice Location

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