Individual
DR. HOMERO RIVAS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5617 HIGHWAY 153, SUITE 103, HIXSON, TN 37343-4675
(423) 485-3226
(423) 485-3302
Mailing address
5617 HIGHWAY 153, SUITE 103, HIXSON, TN 37343-4675
(423) 485-3226
(423) 485-3302
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
42493
TN
208VP0014X
Interventional Pain Medicine Physician
42493
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1506847
—
TN
01
—
4195338
BCBST
TN
Enumeration date
07/31/2007
Last updated
08/01/2013
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