Provider Demographics
NPI:1588711089
Name:RIVAS, FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:RIVAS
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 1:1302 4TH AVE
Mailing Address - Street 2:P O BOX 9129
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2401
Mailing Address - Country:US
Mailing Address - Phone:304-529-3223
Mailing Address - Fax:304-522-2781
Practice Address - Street 1:1302 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2401
Practice Address - Country:US
Practice Address - Phone:304-529-3223
Practice Address - Fax:304-522-2781
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12133207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083160000Medicaid
OH0421449Medicaid
WVRI0474664Medicare ID - Type Unspecified
KY1479301Medicare ID - Type Unspecified
WV0083160000Medicaid
OH0421449Medicaid