Provider Demographics
NPI:1144207291
Name:THORNBURY, DONALD DAVIS JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DAVIS
Last Name:THORNBURY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235003
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5003
Mailing Address - Country:US
Mailing Address - Phone:334-274-9000
Mailing Address - Fax:334-274-0857
Practice Address - Street 1:4294 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3604
Practice Address - Country:US
Practice Address - Phone:334-274-8000
Practice Address - Fax:334-274-0857
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9439207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000032889Medicaid
200003492OtherRR MEDICARE
2002168OtherRR MEDICARE
4578111OtherAETNA
51032889OtherBLUE CROSS
550364OtherPRIME HEALTH
0910213OtherUNITED HEALTHCARE
AL000032890Medicaid
AL000015122Medicaid
51015122OtherBLUE CROSS
51032890OtherBLUE CROSS
658397OtherFIRST HEALTH
6451OtherNCC/TYNET
51015122OtherBLUE CROSS
AL000032889Medicaid
AL000015122Medicaid
H429Medicare PIN
J030Medicare PIN
51032890OtherBLUE CROSS
6451OtherNCC/TYNET
H430Medicare PIN
4578111OtherAETNA
H431Medicare PIN