Provider Demographics
NPI: | 1497744122 |
---|---|
Name: | RIVERA-LINARES, CANDIDO EDGARDO (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CANDIDO |
Middle Name: | EDGARDO |
Last Name: | RIVERA-LINARES |
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: | 4500 SAN PABLO RD S |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32224-1865 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 904-953-2000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4500 SAN PABLO RD S |
Practice Address - Street 2: | |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32224-1865 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-953-2000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-15 |
Last Update Date: | 2020-08-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME84890 | 207RH0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 830008407 | Other | RAILROAD MEDICARE |
FL | 13546 | Other | BLUECROSS/BLUESHIELD |
FL | 264171200 | Medicaid | |
FL | 13546 | Other | BLUECROSS/BLUESHIELD |
FL | F9476 | Medicare UPIN |