Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 15135 | AL |
N | 208D00000X | General Practice Physician | 15135 | AL |
NPI | 1154378495 |
---|---|
Provider Name | Ian H Thorneycroft |
First Address | Mobile, AL 36608-2311 |
Second Address | Mobile, AL 36608-2311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B65797 | (02) | AL |