Provider Demographics
NPI:1053402164
Name:DAVIS, THOMAS MOORE JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MOORE
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HELEN KELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2960
Mailing Address - Country:US
Mailing Address - Phone:205-556-9400
Mailing Address - Fax:205-556-4655
Practice Address - Street 1:700 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2960
Practice Address - Country:US
Practice Address - Phone:205-556-9400
Practice Address - Fax:205-556-4655
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14788207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL83834OtherBCBS
AL000083834Medicaid
F887OtherMEDICARE GROUP
AL000083834Medicaid
AL000083834Medicare PIN