Provider Demographics
NPI:1427198746
Name:RIVIERE WILLIAM, JEAN (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:RIVIERE WILLIAM
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:TORRE MEDICA DR. PEDRO BLANCO LUGO
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-8337
Mailing Address - Fax:787-854-3287
Practice Address - Street 1:TORRE MEDICA DR. PEDRO BLANCO LUGO
Practice Address - Street 2:SUITE 205
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-8337
Practice Address - Fax:787-854-3287
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14781208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022535Medicare ID - Type Unspecified
PRI27119Medicare UPIN