Provider Demographics
NPI:1982939120
Name:TROY EAR NOSE AND THROAT
Entity type:Organization
Organization Name:TROY EAR NOSE AND THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:334-807-8448
Mailing Address - Street 1:1320 HIGHWAY 231 S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3000
Mailing Address - Country:US
Mailing Address - Phone:334-807-8448
Mailing Address - Fax:334-807-6099
Practice Address - Street 1:1320 HIGHWAY 231 S
Practice Address - Street 2:SUITE 3
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3000
Practice Address - Country:US
Practice Address - Phone:334-807-8448
Practice Address - Fax:334-807-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6245207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093706905OtherNPI