Provider Demographics
NPI:1831146901
Name:WEATHERFORD, ELIZABETH R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:R
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0298
Mailing Address - Country:US
Mailing Address - Phone:256-767-7494
Mailing Address - Fax:256-760-8432
Practice Address - Street 1:1404 E AVALON AVE
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1773
Practice Address - Country:US
Practice Address - Phone:256-381-4400
Practice Address - Fax:256-381-4783
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000157782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-31111OtherBCBS-401 COLLEGE FLO, AL
AL009939493Medicaid
AL51515569OtherBCBS
AL51509167WEAOtherBCBS
AL51536614OtherBCBS-WINFIELD, AL
AL51537209Other2030 CHESTNUT, MONTGOMERY
AL051509167Medicaid
AL631053058013OtherTRICARE
AL009939496Medicaid
AL51536676OtherBCBS-ARDMORE, AL
AL51536677OtherBCBS-ATHENS, AL
AL51537005OtherBCBS-RUSSELLVILLE 15225
AL515-38566OtherBCBS-CENTRE, AL
AL009939494Medicaid
AL009939497Medicaid
AL51536678OtherBCBS-CALERA, AL
AL51536928OtherBCBS-4831 SPARKMAN DR
AL51515569OtherBCBS
AL51536614OtherBCBS-WINFIELD, AL
AL009939494Medicaid