Provider Demographics
NPI:1023102555
Name:PASTOR H. RIOS, MD
Entity type:Organization
Organization Name:PASTOR H. RIOS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PASTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-755-0500
Mailing Address - Street 1:449 SE BAYA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-755-0500
Mailing Address - Fax:386-755-9217
Practice Address - Street 1:449 SE BAYA DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-755-0500
Practice Address - Fax:386-755-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07742OtherBCBS PROVIDER NUMBER
FL257957000Medicaid
FL030461OtherAVMED PROVIDER NUMBER
FLK1482Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLE21414Medicare UPIN