Healthcare Provider Details

I. General information

NPI: 1225031743
Provider Name (Legal Business Name): FREDERICK JOHN ELSAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 19TH ST S
BIRMINGHAM AL
35205-4804
US

IV. Provider business mailing address

1000 19TH ST S
BIRMINGHAM AL
35205-4804
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-0700
  • Fax: 205-930-9127
Mailing address:
  • Phone: 205-930-0700
  • Fax: 205-930-9127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7607
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: