Provider Demographics
NPI:1730171216
Name:RIOS, LUIS MANUEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MANUEL
Last Name:RIOS
Suffix:JR
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 1:2101 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8301
Mailing Address - Country:US
Mailing Address - Phone:956-682-3147
Mailing Address - Fax:956-682-3511
Practice Address - Street 1:2101 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8301
Practice Address - Country:US
Practice Address - Phone:956-682-3147
Practice Address - Fax:956-682-3511
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ02212086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152179101Medicaid
TX742883624OtherWORKERS COMP #
742883624OtherFEDERAL TAX ID#
TX8B6021OtherBLUE CROSS PROVIDER #
TX0059GSOtherBLUE CROSS/BLUE SHIELD GROUP
TX031479101Medicaid
TX8B6021OtherBLUE CROSS PROVIDER #
TX152179101Medicaid
TX00701RMedicare PIN