Healthcare Provider Details

I. General information

NPI: 1568468270
Provider Name (Legal Business Name): JAMES EARNEST ELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 INDEPENDENCE DR
BIRMINGHAM AL
35209-5710
US

IV. Provider business mailing address

3560 INDEPENDENCE DR
BIRMINGHAM AL
35209-5722
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2806
  • Fax: 205-949-2875
Mailing address:
  • Phone: 205-949-2806
  • Fax: 205-949-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number11242
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME93129
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number056703
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2005-01455
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number41316
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number31214
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number0101244538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: