Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 39776 | TX |
NPI | 1013990761 |
---|---|
Provider Name | Dr. Eliseo Rivera |
First Address | Odessa, TX 79765-8527 |
Second Address | Odessa, TX 79765-8527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 25/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46002 | (02) | TX |