Provider Demographics
NPI:1972706372
Name:WALSH, STEPHANIE BEATROUS (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BEATROUS
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD AVE S
Mailing Address - Street 2:EFH 414
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0009
Mailing Address - Country:US
Mailing Address - Phone:205-934-5188
Mailing Address - Fax:205-934-5766
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:SUITE 3RD FLOOR
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-996-7546
Practice Address - Fax:205-934-5766
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29213207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology