Provider Demographics
NPI:1518071364
Name:RIVERS, TERRY NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:NEAL
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 2269
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-2269
Mailing Address - Country:US
Mailing Address - Phone:251-680-9596
Mailing Address - Fax:251-928-9841
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:UNIV OF SOUTH AL MEDICAL CENTER
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2293
Practice Address - Country:US
Practice Address - Phone:251-471-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12493207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72746Medicare UPIN