Provider Demographics
NPI:1295818573
Name:CHIVERS R WOODRUFF MD PC
Entity Type:Organization
Organization Name:CHIVERS R WOODRUFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:CHIVERS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-532-1888
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00077538OtherMEDICARE RAILROAD