Provider Demographics
NPI:1215919485
Name:RIVERA, JOSE J (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 W HILLSBOROUGH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1059
Mailing Address - Country:US
Mailing Address - Phone:813-872-4492
Mailing Address - Fax:813-870-1502
Practice Address - Street 1:2333 W HILLSBOROUGH AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1059
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:813-870-1502
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35429207L00000X, 208VP0014X
FLME103262208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$00OtherBUREAU OF WORKERS COMP
$$$$$$$$$00OtherBUREAU OF WORKERS COMP
P00827915Medicare PIN
0918170Medicare PIN