Individual
EDGARDO RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 263-5666
(928) 692-4648
Mailing address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 263-5666
(928) 692-4648
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
44221
AZ
207RX0202X
Medical Oncology Physician
J1479
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041341102
—
TX
01
—
8W1057
BLUE CROSS BLUE SHIELD
TX
01
—
P00442974
RAILROAD MEDICARE
TX
Enumeration date
03/05/2007
Last updated
07/07/2016
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