Provider Demographics
NPI:1184829046
Name:BRACKETT, STEPHEN RONALD DOUGLAS BO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RONALD DOUGLAS BO
Last Name:BRACKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2204
Mailing Address - Country:US
Mailing Address - Phone:205-731-9090
Mailing Address - Fax:
Practice Address - Street 1:2124 4TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2204
Practice Address - Country:US
Practice Address - Phone:205-731-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL313212084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry