Provider Demographics
NPI:1154573830
Name:RIVERA, GUSTAVO D (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:D
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1064 GOODLETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-649-1186
Mailing Address - Fax:239-649-1156
Practice Address - Street 1:1064 GOODLETTE ROAD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-649-1186
Practice Address - Fax:239-649-1156
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR27156R207R00000X
FLME118032207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine