Provider Demographics
NPI:1053394262
Name:RIVKEES, SCOTT ANDREWS (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREWS
Last Name:RIVKEES
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-9001
Mailing Address - Fax:352-294-5247
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-9001
Practice Address - Fax:352-294-5247
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0356392080P0205X
FLME1117042080P0205X
FLME 1117042080P0205X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001356395Medicaid
FL004391900Medicaid
D87796Medicare UPIN
FL004391900Medicaid
FLFS270ZMedicare PIN