Individual
EUGENIO RIVERA REVERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
(505) 722-1421
Mailing address
P.O. BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 722-1421
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
011196
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56852827
—
NM
05
—
803694
—
AZ
Enumeration date
06/15/2006
Last updated
07/23/2012
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