Healthcare Provider Details

I. General information

NPI: 1497730766
Provider Name (Legal Business Name): STEPHEN H MUNDERLOH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST
MOBILE AL
36608-0525
US

IV. Provider business mailing address

PO BOX 91628
MOBILE AL
36691-1628
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-3921
  • Fax: 251-476-5460
Mailing address:
  • Phone: 251-460-0326
  • Fax: 251-460-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12525
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: