Provider Demographics
NPI:1417922683
Name:MORAN, STEPHAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:G
Last Name:MORAN
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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-4595
Mailing Address - Fax:256-265-4599
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-265-2895
Practice Address - Fax:256-265-9777
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000211952086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520526OtherBCBS
TN4046898Medicaid
AL009947965Medicaid
TN4086146OtherBCBS
ALH11595Medicare UPIN
ALP00169899Medicare PIN
AL051520526Medicare PIN