Provider Demographics
NPI:1780648295
Name:RIOS, GUSTAVO ERNESTO (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ERNESTO
Last Name:RIOS
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 TWEED DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4591
Mailing Address - Country:US
Mailing Address - Phone:910-687-0364
Mailing Address - Fax:
Practice Address - Street 1:120 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-0581
Practice Address - Fax:910-353-1351
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07719500208000000X
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics