Healthcare Provider Details

I. General information

NPI: 1982939120
Provider Name (Legal Business Name): TROY EAR NOSE AND THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 HIGHWAY 231 S SUITE 3
TROY AL
36081-3000
US

IV. Provider business mailing address

1320 HIGHWAY 231 S SUITE 3
TROY AL
36081-3000
US

V. Phone/Fax

Practice location:
  • Phone: 334-807-8448
  • Fax: 334-807-6099
Mailing address:
  • Phone: 334-807-8448
  • Fax: 334-807-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number6245
License Number StateAL

VIII. Authorized Official

Name: DR. WILTON DAVID MCRAE
Title or Position: OWNER
Credential: M. D.
Phone: 334-807-8448