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General NPI Number Information
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NPI Number | 1700093986
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Entity Type | Organization
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Legal Business Name | EAR, NOSE, AND THROAT CLINIC, P.A.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 652 LOMB AVE SW
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City | BIRMINGHAM
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State | AL
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Zip | 35211-1330
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Country | US
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Telephone | 205-787-1457
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Fax | 205-788-0073
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Provider Business Mailing Address
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Address Line | 652 LOMB AVE SW
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City | BIRMINGHAM
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State | AL
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Zip | 35211-1330
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Country | US
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Telephone | 205-787-1457
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Fax | 205-788-0073
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK M DABBS
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Credential | M.D.
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Telephone | 205-787-1457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD2799
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License Number State | AL
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