Provider Demographics
NPI:1588663538
Name:WEINACKER, ELIZABETH SMITH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SMITH
Last Name:WEINACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:610 PROVIDENCE PARK DR E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4622
Mailing Address - Country:US
Mailing Address - Phone:251-639-1300
Mailing Address - Fax:251-639-1380
Practice Address - Street 1:610 PROVIDENCE PARK DR E
Practice Address - Street 2:SUITE 201
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4622
Practice Address - Country:US
Practice Address - Phone:251-639-1300
Practice Address - Fax:251-639-1380
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL25823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I24098Medicare UPIN