Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | ME0082451 | FL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME0082451 | FL |
NPI | 1699860122 |
---|---|
Provider Name | Dr. Miguel A Rivera |
First Address | Tampa, FL 33619-8327 |
Second Address | Brandon, FL 33511-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266573500 | (05) | FL |
H84581 | (02) | FL |