Provider Demographics
NPI:1275516981
Name:RIVAS, JOSE ROLANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROLANDO
Last Name:RIVAS
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 1:5146 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6419
Mailing Address - Country:US
Mailing Address - Phone:214-515-5584
Mailing Address - Fax:214-515-9921
Practice Address - Street 1:2696 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:972-487-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4846207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX48643200OtherDEPT. OF LABOR
TX8X5664OtherBLUE CROSS/BLUE SHIELD
E02287Medicare UPIN
TX8C6269Medicare PIN
819651Medicare ID - Type Unspecified