Provider Demographics
NPI:1487610697
Name:RIBER, EZRA B (MD)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:B
Last Name:RIBER
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 198978
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8978
Mailing Address - Country:US
Mailing Address - Phone:803-779-3263
Mailing Address - Fax:803-779-3207
Practice Address - Street 1:1655 BERNARDIN AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2044
Practice Address - Country:US
Practice Address - Phone:803-779-3263
Practice Address - Fax:803-779-3207
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13894208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC138942Medicaid
SC050076865OtherRAILROAD MEDICARE
SCB91429Medicare UPIN
SCB914290281Medicare PIN