1396785929 NPI number — ELIZABETH D CALDWELL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396785929 NPI number — ELIZABETH D CALDWELL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CALDWELL

Provider First Name:

ELIZABETH

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1396785929

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/28/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

208 MCFARLAND CIR N

Provider Second Line Business Mailing Address:

SUITE 100

Provider Business Mailing Address City Name:

TUSCALOOSA

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35406-1800

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-345-7000

Provider Business Mailing Address Fax Number:

205-343-0910

Provider First Line Business Practice Location Address:

208 MCFARLAND CIR N

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TUSCALOOSA

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

35406-1800

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

205-345-7000

Provider Business Practice Location Address Fax Number:

205-343-0910

Provider Enumeration Date:

06/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  18761 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 009988700 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989100 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 000036420 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989080 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989110 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989070 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989090 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009988710 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989040 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989060 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009992390 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009988680 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009988690 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989050 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".