Provider Demographics
NPI:1659473098
Name:RIVERA, DAVID ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ENRIQUE
Last Name:RIVERA
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 1:4635 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3853
Mailing Address - Country:US
Mailing Address - Phone:706-823-2244
Mailing Address - Fax:
Practice Address - Street 1:ONE FREEDOM WAY
Practice Address - Street 2:AUGUSTA VETERANS AFFAIRS MEDICAL CENTER
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6285
Practice Address - Country:US
Practice Address - Phone:706-823-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39214208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery