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1386616530

NPI Code Detail

MEDICARE: DR. STEPHEN DONALD MALLARD M.D.

MEDICARE: DR. STEPHEN DONALD MALLARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	00019373	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	051032090	OTHER	AL	BLUE SHIELD OF ALABAMA
5	051032095	OTHER	AL	BLUE SHIELD OF ALABAMA
6	051513704	OTHER	AL	BLUE SHIELD OF ALABAMA
7	051516185	OTHER	AL	BLUE SHIELD OF ALABAMA
8	051528591	OTHER	AL	BLUE SHIELD OF ALABAMA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	051513705	OTHER	AL	BLUE SHIELD OF ALABAMA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	051520380	OTHER	AL	BLUE SHIELD OF ALABAMA
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386616530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN DONALD MALLARD M.D.

Provider Business Mailing Address
First Line	:	1400 6TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1502
Country	:	US
Telephone Number	:	205-930-1501
Fax Number	:	205-930-0243

Provider Business Practice Location Address
First Line	:	1400 6TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1502
Country	:	US
Telephone Number	:	205-930-1501
Fax Number	:	205-930-0243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	02/18/2011

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Directions to “ DR. STEPHEN DONALD MALLARD M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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