Provider Demographics
NPI:1013990761
Name:RIVERA, ELISEO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISEO
Middle Name:
Last Name:RIVERA
Suffix:
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 1:8221 SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8527
Mailing Address - Country:US
Mailing Address - Phone:432-272-4382
Mailing Address - Fax:432-272-4382
Practice Address - Street 1:8221 SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8527
Practice Address - Country:US
Practice Address - Phone:432-272-4382
Practice Address - Fax:432-272-4382
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L1864Medicare PIN
TXH46002Medicare UPIN