Provider Demographics
NPI:1780780858
Name:RIVERA, EFRAIN JR (MD)
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EFRAIN
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 222187
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-5187
Mailing Address - Country:US
Mailing Address - Phone:915-261-7226
Mailing Address - Fax:915-519-4300
Practice Address - Street 1:1717 BROWN ST STE 3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4730
Practice Address - Country:US
Practice Address - Phone:915-261-7226
Practice Address - Fax:915-231-6769
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1525207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U4601OtherBCBS
TX129999208Medicaid
TX8S2590OtherBCBS
TX129999206Medicaid
C21105Medicare UPIN
TX129999208Medicaid
TX129999206Medicaid