Healthcare Provider Details

I. General information

NPI: 1063838167
Provider Name (Legal Business Name): EAR NOSE AND THROAT ASSOCIATES OF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MCFARLAND BLVD NE STE A
TUSCALOOSA AL
35406-2288
US

IV. Provider business mailing address

1224 MCFARLAND BLVD NE STE A
TUSCALOOSA AL
35406-2288
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-3330
  • Fax: 205-333-3331
Mailing address:
  • Phone: 205-333-3330
  • Fax: 205-333-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number17829
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number17829
License Number StateAL

VIII. Authorized Official

Name: DR. SALEM K DAVID JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-333-3330