Provider Demographics
NPI:1487690764
Name:ST JOHN, ELAINE B (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:B
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 55823
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5823
Mailing Address - Country:US
Mailing Address - Phone:205-996-2244
Mailing Address - Fax:205-996-2254
Practice Address - Street 1:525 NHB
Practice Address - Street 2:619 SOUTH 19TH STREET
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-0001
Practice Address - Country:US
Practice Address - Phone:205-996-2244
Practice Address - Fax:205-996-2254
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL112102080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00114023OtherMISSISSIPPI MEDICAID
AL4710039OtherUHC
510-17015OtherBC BS
C76552OtherVIVA
AL00485207XOtherGEORGIA MEDICAID
AL2218OtherHEALTHSPRING
AL00114023OtherMISSISSIPPI MEDICAID