Provider Demographics
NPI:1093715658
Name:RIVELAND, BRIAN R (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:RIVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27820 N 15TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5373
Mailing Address - Country:US
Mailing Address - Phone:602-697-7527
Mailing Address - Fax:480-336-8349
Practice Address - Street 1:27820 N 15TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5373
Practice Address - Country:US
Practice Address - Phone:602-697-7527
Practice Address - Fax:480-336-8349
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.052781207R00000X
CODR.0069828207R00000X
HIMD-23143207R00000X
ORMD213420207R00000X
IL036.157488207R00000X
AZ17030207R00000X
FLME148147207R00000X
TXAM00196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCGBRMedicare UPIN
AZCD5921Medicare PIN