Organization
ETHER BUNNY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA LEE DESVERREAUX (BILLING CONTACT)
(251) 965-5393
Entity
Organization
Contact information
Practice address
1613 N MCKENZIE ST, FOLEY, AL 36535-2247
(251) 965-5393
(251) 971-1029
Mailing address
PO BOX 969, MAGNOLIA SPRINGS, AL 36555-0969
(251) 965-5393
(251) 971-1029
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529907430
—
AL
Enumeration date
07/05/2005
Last updated
04/07/2009
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