Provider Demographics
NPI:1497062186
Name:RIVERA-RODRIGUEZ, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:RIVERA-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:E
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 S FORT HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3908
Mailing Address - Country:US
Mailing Address - Phone:727-447-5454
Mailing Address - Fax:727-287-4564
Practice Address - Street 1:1100 S FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3908
Practice Address - Country:US
Practice Address - Phone:727-447-5454
Practice Address - Fax:727-287-4564
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8180207R00000X
FLME127224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP8180OtherTEXAS MEDICAL BOARD
FL017235400Medicaid