Provider Demographics
NPI:1386616530
Name:MALLARD, STEPHEN DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DONALD
Last Name:MALLARD
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 1:1400 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-930-1501
Mailing Address - Fax:205-930-0243
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1502
Practice Address - Country:US
Practice Address - Phone:205-930-1501
Practice Address - Fax:205-930-0243
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL303700331Medicaid
AL303720331Medicaid
AL303790331Medicaid
AL051032090OtherBLUE SHIELD OF ALABAMA
AL051032095OtherBLUE SHIELD OF ALABAMA
AL051513704OtherBLUE SHIELD OF ALABAMA
AL051516185OtherBLUE SHIELD OF ALABAMA
AL051528591OtherBLUE SHIELD OF ALABAMA
AL303760331Medicaid
AL051513705OtherBLUE SHIELD OF ALABAMA
AL303740331Medicaid
AL303730331Medicaid
AL051520380OtherBLUE SHIELD OF ALABAMA
AL303710331Medicaid
AL051516185OtherBLUE SHIELD OF ALABAMA