Provider Demographics
NPI:1861402018
Name:RIVARD, MATTHEW J (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:RIVARD
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 1:16909 LAKESIDE HILLS CT
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4664
Mailing Address - Country:US
Mailing Address - Phone:402-758-5250
Mailing Address - Fax:402-758-8255
Practice Address - Street 1:16909 LAKESIDE HILLS CT
Practice Address - Street 2:SUITE 211
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4664
Practice Address - Country:US
Practice Address - Phone:402-758-5250
Practice Address - Fax:402-758-8255
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20584208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE17-01047OtherSHARE ADVANTAGE/IMMANUEL
IA00973OtherBCBS IOWA
IA0593186Medicaid
NE17-01046OtherSHARE ADVANTAGE LAKESIDE
NE247749OtherMIDLANDS CHOICE
NE30009OtherBCBS NEBRASKA
NE47076756913Medicaid
IAI16350Medicare PIN
NE17-01046OtherSHARE ADVANTAGE LAKESIDE
IA00973OtherBCBS IOWA
NEH07590Medicare UPIN