Basic Information
| Provider Information | |||||||||
| NPI: | 1124108535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL ALABAMA ENT ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6980 WINTON BLOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361173556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342770484 | ||||||||
| FaxNumber: | 3342728877 | ||||||||
| Practice Location | |||||||||
| Address1: | 6980 WINTON BLOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361173556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342770484 | ||||||||
| FaxNumber: | 3342728877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | VAUGHAN | ||||||||
| AuthorizedOfficialFirstName: | WALLACE | ||||||||
| AuthorizedOfficialMiddleName: | CARROLL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3342770484 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.