Provider Demographics
NPI:1609828110
Name:RIVES, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:RIVES
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 1:2021 PROFESSIONAL CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5174
Mailing Address - Country:US
Mailing Address - Phone:912-350-8404
Mailing Address - Fax:912-350-8067
Practice Address - Street 1:2021 PROFESSIONAL CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:912-350-8404
Practice Address - Fax:912-350-8067
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33705207P00000X, 208M00000X
GA061646207Q00000X
FLME124964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
582162071-014OtherHMHS/TRICARE SOUTH
01230056OtherAMERIGROUP
GA479466OtherWELLCARE
GA631688987AMedicaid
SCG61646Medicaid
GAP00649638OtherRR MEDICARE
GA631688987AMedicaid
C56598Medicare UPIN