Provider Demographics
NPI:1982670758
Name:RIVERS, ERIK C (PA)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:C
Last Name:RIVERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MARKET PTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:952-767-4574
Mailing Address - Fax:952-835-4403
Practice Address - Street 1:4300 MARKET PTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-767-4574
Practice Address - Fax:952-835-4403
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9272363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA9091021565OtherPREFERRED ONE
MN1982670758OtherMEDICA
MN73L03RIOtherBLUE CROSS BLUE SHIELD MN
MN908143700Medicaid
MN1982670758OtherMEDICA
MNNA9091021565OtherPREFERRED ONE