Individual
ELIZABETH ANN MOUNTCASTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
00009695
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-3970660
FED TAX #
—
01
—
510-82148
BLUE CROSS BLUE SHIELD
AL
01
—
511-30221
BCBS
AL
05
—
528501290
—
AL
01
—
631066099
TAX#
AL
01
—
CM4358
RR MCR
AL
Enumeration date
08/30/2006
Last updated
01/09/2013
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