Provider Demographics
NPI:1699860122
Name:RIVERA, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:SELECT PHYSICIANS ALLIANCE
Mailing Address - Street 2:10002 PRINCESS PALM AVE. STE 332
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8327
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:FLORIDA ENT & ALLERGY
Practice Address - Street 2:1139 NIKKI VIEW DR.
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4879
Practice Address - Country:US
Practice Address - Phone:813-879-8045
Practice Address - Fax:813-685-2477
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-05-07
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Provider Licenses
StateLicense IDTaxonomies
FLME0082451207YS0123X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266573500Medicaid
FLH84581Medicare UPIN
FL266573500Medicaid