Provider Demographics
NPI:1063838167
Name:EAR NOSE AND THROAT ASSOCIATES OF
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEM
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-333-3330
Mailing Address - Street 1:1224 MCFARLAND BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2288
Mailing Address - Country:US
Mailing Address - Phone:205-333-3330
Mailing Address - Fax:205-333-3331
Practice Address - Street 1:1224 MCFARLAND BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2288
Practice Address - Country:US
Practice Address - Phone:205-333-3330
Practice Address - Fax:205-333-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17829207YX0905X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty