Provider Demographics
NPI:1750353132
Name:RIOS, LUIS ERNESTO JR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ERNESTO
Last Name:RIOS
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8795
Mailing Address - Country:US
Mailing Address - Phone:904-284-8700
Mailing Address - Fax:
Practice Address - Street 1:2409 STOCKTON DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8795
Practice Address - Country:US
Practice Address - Phone:904-284-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055184207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA211969812AMedicaid
FL3703495-00Medicaid
FL14718YMedicare PIN
FLD74161Medicare UPIN
FL3703495-00Medicaid