Provider Demographics
NPI:1194036178
Name:PAUL C. RIVARD DPM PC
Entity Type:Organization
Organization Name:PAUL C. RIVARD DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:865-558-0006
Mailing Address - Street 1:6311 KINGSTON PIKE STE 10W
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4906
Mailing Address - Country:US
Mailing Address - Phone:865-558-0006
Mailing Address - Fax:865-558-9462
Practice Address - Street 1:6311 KINGSTON PIKE STE 10W
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-558-0006
Practice Address - Fax:865-558-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM295213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351417Medicaid
TN3351417Medicare UPIN