Provider Demographics
NPI:1235121492
Name:MOSTELLER, CHARLES STEBNER (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEBNER
Last Name:MOSTELLER
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 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-341-3368
Mailing Address - Fax:251-341-3371
Practice Address - Street 1:3701 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1756
Practice Address - Country:US
Practice Address - Phone:251-341-3368
Practice Address - Fax:251-341-3371
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014530207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0810135OtherUNITED HEALTHCARE PROV #
AL51034523OtherBLUE CROSS PROVIDER #
AL4204103OtherAETNA PIN
ALE56728OtherHEALTHSPRING PROVIDER #
AL4204103OtherAETNA PIN