Provider Demographics
NPI:1003929886
Name:RIASE, SAMUEL JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:RIASE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:535 JACK WARNER PKWY NE
Mailing Address - Street 2:G-2
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5751
Mailing Address - Country:US
Mailing Address - Phone:205-507-1264
Mailing Address - Fax:205-507-1266
Practice Address - Street 1:535 JACK WARNER PKWY NE
Practice Address - Street 2:G-2
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5751
Practice Address - Country:US
Practice Address - Phone:205-507-1264
Practice Address - Fax:205-507-1266
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist