Individual
EDGARDO H RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 STATE ROUTE 664 N, LOGAN, OH 43138-8541
(740) 380-8000
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4304
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35073841R
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000315925
BCBS
—
05
—
2084506
—
OH
Enumeration date
05/12/2006
Last updated
05/29/2008
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