Provider Demographics
NPI:1003855305
Name:RIOS, EDUARDO L (PA-C)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:L
Last Name:RIOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PINELLAS ST STE 325
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3320
Mailing Address - Country:US
Mailing Address - Phone:727-298-6121
Mailing Address - Fax:727-461-8705
Practice Address - Street 1:400 PINELLAS ST
Practice Address - Street 2:SUITE 325
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3312
Practice Address - Country:US
Practice Address - Phone:727-298-6121
Practice Address - Fax:727-461-8705
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102764363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291889700Medicaid
FLP01334569OtherRAILROAD MEDICARE PROVIDER NUMBER
FLU2927XMedicare PIN
FLU2927YMedicare PIN
FLP01334569OtherRAILROAD MEDICARE PROVIDER NUMBER