Individual
EDUARDO G RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
122 DEMAREE DR, MADISON, IN 47250-4622
(812) 265-9191
(812) 265-1050
Mailing address
122 DEMAREE DR, MADISON, IN 47250-4622
(812) 265-9191
(812) 265-1050
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
01050279
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368119
ANTHEM BCBS IN PROV NUMB
IN
01
—
065504
COLUMBUS SIHO ID
IN
01
—
20897
IN HEALTH NETWORK ID
IN
05
—
50007573
—
KY
01
—
7514003
AETNA PROVIDER NUMBER
IN
Enumeration date
11/29/2006
Last updated
12/18/2009
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