Provider Demographics
NPI:1932106176
Name:GONZALEZ RIVERA, EDUARDO L SR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:L
Last Name:GONZALEZ RIVERA
Suffix:SR
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 1:405 JB RODRIGUEZ
Mailing Address - Street 2:1703-1 MIRADOR DEL PARQUE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-380-6992
Mailing Address - Fax:
Practice Address - Street 1:3010 E 138TH AVE
Practice Address - Street 2:#100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3904
Practice Address - Country:US
Practice Address - Phone:813-569-0794
Practice Address - Fax:813-333-7358
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5608207LP2900X
FLME 121448207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27008Medicare ID - Type Unspecified
PRC78130Medicare UPIN