Basic Information
| Provider Information | |||||||||
| NPI: | 1972706372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | BEATROUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 3RD AVE S | ||||||||
| Address2: | EFH 414 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059345188 | ||||||||
| FaxNumber: | 2059345766 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 6TH AVE S | ||||||||
| Address2: | SUITE 3RD FLOOR | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352332110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059967546 | ||||||||
| FaxNumber: | 2059345766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 11/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 29213 | AL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.