Provider Demographics
NPI:1871569665
Name:RIVERA, ALAN LEN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:LEN
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1735
Mailing Address - Country:US
Mailing Address - Phone:419-335-3242
Mailing Address - Fax:419-335-3222
Practice Address - Street 1:735 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1735
Practice Address - Country:US
Practice Address - Phone:419-335-3242
Practice Address - Fax:419-335-3222
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078607207R00000X, 208M00000X
GA057245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist