Provider Demographics
NPI:1780629915
Name:RIVAS, ALEJANDRO ALBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:ALBERTO
Last Name:RIVAS
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 1:3215 LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138
Mailing Address - Country:US
Mailing Address - Phone:615-889-4212
Mailing Address - Fax:615-889-3906
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207
Practice Address - Country:US
Practice Address - Phone:615-889-4212
Practice Address - Fax:615-889-3906
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10953173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3168734Medicaid
TN3168734Medicare ID - Type Unspecified
TN3168734Medicaid
1780629915Medicare NSC