=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538201553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH BLAIR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 11/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3686 GRANDVIEW PKWY STE 800
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-858-0900
-----------------------------------------------------
Fax | 205-858-0901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 MEDICAL PARK DR E SUITE 355
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35235-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-838-3036
-----------------------------------------------------
Fax | 205-838-5832
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD.26371
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------