Healthcare Provider Details

I. General information

NPI: 1215101092
Provider Name (Legal Business Name): STEPHEN THOMAS IKARD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2055
US

IV. Provider business mailing address

PO BOX 2447
TUSCALOOSA AL
35403-2447
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax: 205-345-7341
Mailing address:
  • Phone: 205-345-0192
  • Fax: 205-247-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME117010
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD33310
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: