Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 14828 | AL |
NPI | 1386683902 |
---|---|
Provider Name | Dr. Melvin Delaine Thornbury JR. |
First Address | Albertville, AL 35951-7209 |
Second Address | Albertville, AL 35950-1733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51550422 | (05) | AL |
51550422 | BLUE CROSS BLUE SHIELD (01) | AL |
E45306 | (02) | AL |