Provider Demographics
NPI:1780650754
Name:RIEGO, FILMORE ALTEROS (MD)
Entity Type:Individual
Prefix:
First Name:FILMORE
Middle Name:ALTEROS
Last Name:RIEGO
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 1:1462 MARION WALDO RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7422
Mailing Address - Country:US
Mailing Address - Phone:740-389-5418
Mailing Address - Fax:740-389-5410
Practice Address - Street 1:1462 MARION WALDO RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7422
Practice Address - Country:US
Practice Address - Phone:740-389-5418
Practice Address - Fax:740-389-5410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-2709207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000218578OtherANTHEM BC/BS
0801636OtherUNITED HEALTHCARE
0004467241OtherAETNA
OH0369891Medicaid
000000218578OtherANTHEM BC/BS
A77753Medicare UPIN