Provider Demographics
NPI:1619171295
Name:RIOS, JAVIER ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ANTONIO
Last Name:RIOS
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:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-332-2286
Mailing Address - Fax:281-336-1549
Practice Address - Street 1:905 W MEDICAL CENTER BLVD # 404
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4009
Practice Address - Country:US
Practice Address - Phone:281-332-2286
Practice Address - Fax:281-336-1549
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8284207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01601513OtherRR MEDICARE
TX8GA657OtherBLUE CROSS BLUE SHIELD
TX8FJ166OtherBLUE CROSS BLUE SHIELD
TX219720402Medicaid
TX219720403Medicaid
TX219720403Medicaid
TX219720402Medicaid