Provider Demographics
NPI:1396776050
Name:STADTHER, JOSEPH L (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:STADTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:820 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-7858
Mailing Address - Country:US
Mailing Address - Phone:251-342-8900
Mailing Address - Fax:251-342-2333
Practice Address - Street 1:820 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 1 B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7858
Practice Address - Country:US
Practice Address - Phone:251-342-8900
Practice Address - Fax:251-342-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL89552080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010549Medicaid
C 76872Medicare UPIN