Provider Demographics
NPI:1447210570
Name:RIVERA, JORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:M
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 1:729 POINSETTIA AVE
Mailing Address - Street 2:APT 40
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-3863
Mailing Address - Country:US
Mailing Address - Phone:863-386-1889
Mailing Address - Fax:
Practice Address - Street 1:3601 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5418
Practice Address - Country:US
Practice Address - Phone:863-382-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07859Medicare ID - Type Unspecified