Provider Demographics
NPI:1114020377
Name:STEPHENS, SELDEN HARBOUR III (MD)
Entity Type:Individual
Prefix:
First Name:SELDEN
Middle Name:HARBOUR
Last Name:STEPHENS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:HARBOUR
Other - Last Name:STEPHENS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:168 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3510
Mailing Address - Country:US
Mailing Address - Phone:251-433-1895
Mailing Address - Fax:251-433-1917
Practice Address - Street 1:168 MOBILE INFIRMARY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3510
Practice Address - Country:US
Practice Address - Phone:251-433-1895
Practice Address - Fax:251-433-1917
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17285208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085160Medicaid
AL051085160OtherBCBS
AL340007067Medicare PIN
ALE46883Medicare UPIN
AL000085160Medicare PIN