Provider Demographics
NPI:1689626046
Name:COULTER, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:COULTER
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 1:550 MEDICAL CENTER DR SW
Mailing Address - Street 2:PO BOX 680199
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3418
Mailing Address - Country:US
Mailing Address - Phone:256-845-8885
Mailing Address - Fax:256-845-9546
Practice Address - Street 1:550 MEDICAL CENTER DRIVE SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3418
Practice Address - Country:US
Practice Address - Phone:256-845-8885
Practice Address - Fax:256-845-9546
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018145174400000X
AL18145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000027249Medicaid
AL27249OtherBCBS
AL27249OtherBCBS
ALF80565Medicare ID - Type Unspecified