Eugenio    Rivera    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004154
NPI
1265613921
Tax ID
260600490
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4343 West Flagler Street Suite 400
Miami, FL 33134
United States
County
Miami-Dade
Phone
3054417030 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address