Basic Information
| Provider Information | |||||||||
| NPI: | 1518132299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIAL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | RANDOLPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 851417 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366851417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3719 DAUPHIN ST. | ||||||||
| Address2: | SPRINGHILL HOSP. MEDICALCENTER-ANESTHEIA DEPT | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366851417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SN0800X | 1-028739 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Neuroscience |
ID Information
| ID | Type | State | Issuer | Description | 72152 | 05 | AL | MEDICAID |