Provider Demographics
NPI:1396795654
Name:ELLIOTT, KIMBERLY A (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-473-1900
Mailing Address - Fax:251-470-8943
Practice Address - Street 1:3701 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1756
Practice Address - Country:US
Practice Address - Phone:251-341-3368
Practice Address - Fax:251-341-3371
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00027234207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003855OtherBLUE CROSS OF AL PROV #
ALI56767OtherHEALTHSPRING PROVIDER #
AL7216824OtherAETNA PROVIDER #
AL51003855OtherBLUE CROSS OF AL PROV #
ALI56767Medicare UPIN