Provider Demographics
NPI:1982707766
Name:ENNIS, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:ENNIS
Suffix:
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 1:840 MONTCLAIR ROAD
Mailing Address - Street 2:SUITE #606
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1920
Mailing Address - Country:US
Mailing Address - Phone:205-592-5917
Mailing Address - Fax:205-599-4911
Practice Address - Street 1:840 MONTCLAIR RD
Practice Address - Street 2:SUITE 606
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1920
Practice Address - Country:US
Practice Address - Phone:205-592-5917
Practice Address - Fax:205-599-4911
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15219207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000027761Medicaid
AL000023825Medicaid
AL000023825Medicaid
AL000027761Medicaid
AL23825Medicare ID - Type UnspecifiedMEDICAL EDUCATION #