Provider Demographics
NPI:1982618260
Name:PARDEN, STEPHEN ROY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROY
Last Name:PARDEN
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 1:119 HIGH PINES RDG
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6373
Mailing Address - Country:US
Mailing Address - Phone:251-751-1461
Mailing Address - Fax:
Practice Address - Street 1:119 HIGH PINES RDG
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-6373
Practice Address - Country:US
Practice Address - Phone:251-751-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013491208600000X
NH12985208600000X
ORMD27134208600000X
WAMD00047412208600000X
ME017342208600000X
WI50462-20208600000X
AK6533208600000X
NE25254208600000X
MS20888208600000X
IN01070627A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000089285Medicaid
IN201348840Medicaid
IN0000001003813OtherANTHEM
INP01618784OtherRAILROAD MEDICARE
NH30206244Medicaid
IN201348840Medicaid
IN0000001003813OtherANTHEM