Provider Demographics
NPI:1740567486
Name:MELVIN D THORNBURY JR MD PC
Entity Type:Organization
Organization Name:MELVIN D THORNBURY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:DELAINE
Authorized Official - Last Name:THORNBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-840-4520
Mailing Address - Street 1:2525 US HIGHWAY 431
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5967
Mailing Address - Country:US
Mailing Address - Phone:256-840-4520
Mailing Address - Fax:256-840-4527
Practice Address - Street 1:2525 US HIGHWAY 431
Practice Address - Street 2:SUITE 220
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5934
Practice Address - Country:US
Practice Address - Phone:256-840-4520
Practice Address - Fax:256-840-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14828207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51550422Medicaid
AL51550422OtherBLUE CROSS BLUE SHIELD
AL51550422OtherBLUE CROSS BLUE SHIELD
AL51550422Medicare PIN