Provider Demographics
NPI:1518963834
Name:RIVERS, THOMAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:RIVERS
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 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2782207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9742OtherBC/BS PROVIDER NUMBER
TXP01034616OtherRAILROAD MEDICARE
TX190714OtherAMERIGROUP NUMBER
TX3285310OtherAETNA HMO NUMBER
TX7050494OtherAETNA PPO NUMBER
TXK2782OtherSTATE LICENSE NUMBER
TX127640406Medicaid
TX127640406Medicaid
TX8A6156Medicare PIN
TX3285310OtherAETNA HMO NUMBER
TX7050494OtherAETNA PPO NUMBER
TXTXB145346Medicare PIN
TX190714OtherAMERIGROUP NUMBER