Provider Demographics
NPI:1689903833
Name:WESTERN, ELIZABETH CHILDRESS (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHILDRESS
Last Name:WESTERN
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 1:701 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 507
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7432
Mailing Address - Country:US
Mailing Address - Phone:205-330-3650
Mailing Address - Fax:205-330-3655
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 507
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7432
Practice Address - Country:US
Practice Address - Phone:205-330-3650
Practice Address - Fax:205-330-3655
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G701388OtherMEDICARE-GROUP
AL138652OtherMEDICAID INDIV.
AL511-27182OtherBC/BS OF AL
AL102I081387OtherMEDICARE-INDIV.
AL138413OtherMEDICAID-GROUP