Provider Demographics
NPI:1326668013
Name:RIVERA, CALEB ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:ZACHARY
Last Name:RIVERA
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 1:2915 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6022
Mailing Address - Country:US
Mailing Address - Phone:307-899-1161
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1816
Practice Address - Country:US
Practice Address - Phone:205-325-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program