Individual
WILFREDO RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7208
(214) 645-0624
(214) 645-0078
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-0624
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
L2601
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062NA
BCBS
TX
05
—
151005901
—
TX
05
—
151005904
—
TX
Enumeration date
04/18/2006
Last updated
02/05/2008
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