Healthcare Provider Details

I. General information

NPI: 1518071364
Provider Name (Legal Business Name): TERRY NEAL RIVERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST UNIV OF SOUTH AL MEDICAL CENTER
MOBILE AL
36617-2293
US

IV. Provider business mailing address

PO BOX 2269
FAIRHOPE AL
36533-2269
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7300
  • Fax:
Mailing address:
  • Phone: 251-680-9596
  • Fax: 251-928-9841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number12493
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: