Healthcare Provider Details

I. General information

NPI: 1639312416
Provider Name (Legal Business Name): STEPHEN BROSSETTE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 SOUTHWOOD RD
BIRMINGHAM AL
35216-1539
US

IV. Provider business mailing address

2139 SOUTHWOOD RD
BIRMINGHAM AL
35216-1539
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-6862
  • Fax:
Mailing address:
  • Phone: 205-978-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number23988
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: