Provider Demographics
NPI:1427015247
Name:SELF, KARL STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:STANLEY
Last Name:SELF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:306 S GREENO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1905
Mailing Address - Country:US
Mailing Address - Phone:251-928-8760
Mailing Address - Fax:251-928-7028
Practice Address - Street 1:306 S GREENO RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1905
Practice Address - Country:US
Practice Address - Phone:251-928-8760
Practice Address - Fax:251-928-7028
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL6916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-83390OtherBLUE CROSS/BLUE SHIELD OF AL
AL000083390Medicaid
AL000083390Medicaid
AL510-83390OtherBLUE CROSS/BLUE SHIELD OF AL