Provider Demographics
NPI:1124115068
Name:RISER, EMILY S (MD)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:S
Last Name:RISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6801
Mailing Address - Country:US
Mailing Address - Phone:205-803-2210
Mailing Address - Fax:205-803-2214
Practice Address - Street 1:509 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6801
Practice Address - Country:US
Practice Address - Phone:205-803-2210
Practice Address - Fax:205-803-2214
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL12139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051505O28Medicaid
ALC74511Medicare UPIN
AL051505028Medicare ID - Type UnspecifiedEMILY RISER