Provider Demographics
NPI:1407875065
Name:RIVERA, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:RIVERA
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 1:4730 N HABANA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7163
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:3450 E FLETCHER AVE
Practice Address - Street 2:STE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4655
Practice Address - Country:US
Practice Address - Phone:813-739-7495
Practice Address - Fax:813-864-0788
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93446207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274485600Medicaid
FLP01099802OtherR&R MEDICARE
FL28653UMedicare PIN
FL28653W - PASCOMedicare PIN
FL274485600Medicaid
FL28653TMedicare PIN