Healthcare Provider Details

I. General information

NPI: 1760915797
Provider Name (Legal Business Name): DR. CATER MERRILL ELLIOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/15/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BLUE LAKE DR STE 110
VESTAVIA AL
35243-2372
US

IV. Provider business mailing address

3104 BLUE LAKE DR STE 110
VESTAVIA AL
35243-2372
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-1949
  • Fax:
Mailing address:
  • Phone: 205-977-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.37471
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: