Provider Demographics
NPI:1205521127
Name:STALDER PLASTIC SURGERY ALABAMA LLC
Entity type:Organization
Organization Name:STALDER PLASTIC SURGERY ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-800-8058
Mailing Address - Street 1:6028 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5824
Mailing Address - Country:US
Mailing Address - Phone:504-800-8058
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD STE B222
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6700
Practice Address - Country:US
Practice Address - Phone:504-800-8058
Practice Address - Fax:504-387-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty