=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972706372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE BEATROUS WALSH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 11/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 6TH AVE S SUITE 3RD FLOOR
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35233-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-996-7546
-----------------------------------------------------
Fax | 205-934-5766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1530 3RD AVE S EFH 414
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35294-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-934-5188
-----------------------------------------------------
Fax | 205-934-5766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 29213
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------