Healthcare Provider Details

I. General information

NPI: 1508806597
Provider Name (Legal Business Name): DAVID THORNTON TRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL DR SUITE 100
FAIRHOPE AL
36532-2043
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE D-330
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-9500
  • Fax: 251-990-9501
Mailing address:
  • Phone: 251-607-9797
  • Fax: 251-607-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number00014278
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number00014278
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: