Provider Demographics
NPI:1316989254
Name:FRITTS, STEPHEN BRENT
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRENT
Last Name:FRITTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 229
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-0229
Mailing Address - Country:US
Mailing Address - Phone:256-381-0400
Mailing Address - Fax:256-386-0065
Practice Address - Street 1:1300 SOUTH MONTGOMERY AVENUE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-6334
Practice Address - Country:US
Practice Address - Phone:256-381-0400
Practice Address - Fax:256-386-0065
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000114442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121825Medicaid
AL51539365OtherBCBS
AL009923395Medicaid
MS00121825Medicaid
000057275Medicare PIN