Provider Demographics
NPI:1124012232
Name:WOODRUFF, CHIVERS R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIVERS
Middle Name:R
Last Name:WOODRUFF
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 660986
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0986
Mailing Address - Country:US
Mailing Address - Phone:256-532-1888
Mailing Address - Fax:256-532-3941
Practice Address - Street 1:1220 17TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4747
Practice Address - Country:US
Practice Address - Phone:256-532-1888
Practice Address - Fax:256-532-3941
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000020921Medicaid
515-44238OtherBCBS
AL009912606Medicaid
P00077538OtherMEDICARE RAILROAD
AL000020921Medicaid
515-44238OtherBCBS
AL000020921Medicare PIN