Provider Demographics
NPI:1699989707
Name:RIVAS, OSLER FC (MD)
Entity type:Individual
Prefix:DR
First Name:OSLER
Middle Name:FC
Last Name:RIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4470 SPANISH TRL
Mailing Address - Street 2:APT. 121
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4903
Mailing Address - Country:US
Mailing Address - Phone:850-453-9368
Mailing Address - Fax:850-453-9319
Practice Address - Street 1:3960 W NAVY BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-1265
Practice Address - Country:US
Practice Address - Phone:850-453-9368
Practice Address - Fax:850-453-9319
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist