Provider Demographics
NPI:1639312416
Name:BROSSETTE, STEPHEN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BROSSETTE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 SOUTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1539
Mailing Address - Country:US
Mailing Address - Phone:205-978-6862
Mailing Address - Fax:
Practice Address - Street 1:2139 SOUTHWOOD RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1539
Practice Address - Country:US
Practice Address - Phone:205-978-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23988207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology