Provider Demographics
NPI:1447425533
Name:AZALEA CITY PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:AZALEA CITY PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-344-1151
Mailing Address - Street 1:101 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:BLDG #3 SUITE #309
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1786
Mailing Address - Country:US
Mailing Address - Phone:251-344-1151
Mailing Address - Fax:251-344-2113
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR
Practice Address - Street 2:BLDG #3 SUITE #309
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1786
Practice Address - Country:US
Practice Address - Phone:251-344-1151
Practice Address - Fax:251-344-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL10348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1194832360OtherDR STEPHEN R SHEPPARD NPI
AL17398OtherBCBSAL PROVIER #
AL1194832360OtherDR STEPHEN R SHEPPARD NPI