Provider Demographics
NPI:1275534984
Name:RIVERA, EUGENE ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:ALBERT
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 1:8940 N KENDALL DR
Mailing Address - Street 2:# 504E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-595-6200
Mailing Address - Fax:786-533-1680
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:# 504E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-595-6200
Practice Address - Fax:786-533-1680
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50085207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047424000Medicaid
FLA01134Medicare UPIN
FL047424000Medicaid