MEDICARE: DAVID M ENNIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	15219	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982707766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M ENNIS M.D.

Provider Business Mailing Address
First Line	:	840 MONTCLAIR ROAD
Second Line	:	SUITE #606
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1920
Country	:	US
Telephone Number	:	205-592-5917
Fax Number	:	205-599-4911

Provider Business Practice Location Address
First Line	:	840 MONTCLAIR RD
Second Line	:	SUITE 606
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1920
Country	:	US
Telephone Number	:	205-592-5917
Fax Number	:	205-599-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	06/28/2023

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Directions to “ DAVID M ENNIS M.D.” Practice Location

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