Individual
YURI OLAF RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 WEEMS ST, PURVIS, MS 39475-4062
(601) 794-2224
(601) 794-6392
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5463
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00120
MS
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09075224
—
MS
01
—
5300264
CIGNA
MS
01
—
9116618
AETNA
MS
Enumeration date
12/12/2006
Last updated
07/23/2020
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