Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 35.134863 | OH |
Y | 207N00000X | Dermatologist | 38604 | AL |
NPI | 1023429396 |
---|---|
Provider Name | Carly Elston |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 19/09/2019 |