Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MT197555 | PA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 54472 | CT |
NPI | 1235440918 |
---|---|
Provider Name | Dr. Daniel Mason Avery III |
First Address | Birmingham, AL 35205-1608 |
Second Address | Birmingham, AL 35211-3521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 17/03/2018 |