Provider Demographics
NPI:1861416372
Name:RIVES, ROGER KENT (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KENT
Last Name:RIVES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1005 HEALTH CENTER DR
Mailing Address - Street 2:SYSTEM PRACTICES
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-258-2576
Mailing Address - Fax:217-258-4175
Practice Address - Street 1:500 HEALTH CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9258
Practice Address - Country:US
Practice Address - Phone:217-258-4186
Practice Address - Fax:217-258-4185
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-03-23
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Provider Licenses
StateLicense IDTaxonomies
IL036061773208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology