Healthcare Provider Details

I. General information

NPI: 1235440918
Provider Name (Legal Business Name): DANIEL MASON AVERY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PRINCETON AVENUE BUILDING 2, SUITE 108
BIRMINGHAM AL
35211-3521
US

IV. Provider business mailing address

833 ST. VINCENT'S DRIVE, BLDG 3, STE 403
BIRMINGHAM AL
35205-1608
US

V. Phone/Fax

Practice location:
  • Phone: 205-781-1950
  • Fax:
Mailing address:
  • Phone: 205-939-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMT197555
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number54472
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: