Provider Demographics
NPI:1386707339
Name:EASTERN SHORE EAR, NOSE & THROAT CLINIC, PC
Entity type:Organization
Organization Name:EASTERN SHORE EAR, NOSE & THROAT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-0300
Mailing Address - Street 1:8096 TWIN BEECH RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7195
Mailing Address - Country:US
Mailing Address - Phone:251-928-0300
Mailing Address - Fax:251-990-1898
Practice Address - Street 1:8096 TWIN BEECH RD UNIT 102
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-7195
Practice Address - Country:US
Practice Address - Phone:251-928-0300
Practice Address - Fax:251-990-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528501890Medicaid