Provider Demographics
NPI:1376519140
Name:RIVERS, RUEBEN N (MD)
Entity Type:Individual
Prefix:
First Name:RUEBEN
Middle Name:N
Last Name:RIVERS
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 15133
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0133
Mailing Address - Country:US
Mailing Address - Phone:919-477-5152
Mailing Address - Fax:919-477-5474
Practice Address - Street 1:1314 MEDICAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4442
Practice Address - Country:US
Practice Address - Phone:910-323-2503
Practice Address - Fax:910-323-4260
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7971895Medicaid
NC71895OtherBLUE CROSS
NCC81372Medicare UPIN
NC202625Medicare PIN