Provider Demographics
NPI:1982678744
Name:RIVERA MACMURRAY, SUZETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:
Last Name:RIVERA MACMURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PONCE DE LEON AVE
Mailing Address - Street 2:STE 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-4033
Mailing Address - Country:US
Mailing Address - Phone:787-723-9595
Mailing Address - Fax:787-723-8051
Practice Address - Street 1:1431 PONCE DE LEON AVE
Practice Address - Street 2:STE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4033
Practice Address - Country:US
Practice Address - Phone:787-723-9595
Practice Address - Fax:787-723-8051
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10551207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07465Medicare UPIN
82666R1Medicare ID - Type Unspecified