MEDICARE: DR. BRIAN KEITH STANSELL MD

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	00022373	AL

General Provider Information

NPI Number	:	1841230729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KEITH STANSELL MD

Provider Business Mailing Address
First Line	:	2815 INDEPENDENCE DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209
Country	:	US
Telephone Number	:	205-879-7888
Fax Number	:	205-879-6822

Provider Business Practice Location Address
First Line	:	2815 INDEPENDENCE DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209
Country	:	US
Telephone Number	:	205-879-7888
Fax Number	:	205-879-6822

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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