Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 80029 | MA |
Y | 208600000X | Surgeon | 80029 | MA |
N | 2086S0102X | Surgical Critical Care | 80029 | MD |
N | 2086S0120X | Pediatric Surgery | 80029 | MA |
N | 2086S0127X | Trauma Surgeon | 80029 | MA |
N | 2086X0206X | Surgical Oncologist | 80029 | MA |
N | 208C00000X | Colorectal Surgeon | 80029 | MA |
NPI | 1487614418 |
---|---|
Provider Name | Dr. Jaime Alfredo Rivera |
First Address | Danvers, MA 01923-3623 |
Second Address | Danvers, MA 01923-3623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042530297 | COMMERICAL (01) | MA |
080029 | TUFTS (01) | MA |
3175219 | (05) | MA |
G62459 | (02) | MA |
RIJ18515 | BLUE CROSS BLUE SHIELD (01) | MA |