Provider Demographics
NPI:1922194620
Name:RIOUX, JOHN P (MD PL)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:RIOUX
Suffix:
Gender:M
Credentials:MD PL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21260 OLEAN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6705
Mailing Address - Country:US
Mailing Address - Phone:941-625-4270
Mailing Address - Fax:941-625-1751
Practice Address - Street 1:21260 OLEAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6705
Practice Address - Country:US
Practice Address - Phone:941-625-4270
Practice Address - Fax:941-625-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7078180OtherAETNA
FL252909200Medicaid
FL41412OtherBLUE CROSS BLUE SHIELD
FL7078180OtherAETNA
FLG57719Medicare UPIN