Individual
STEPHENIE B WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 7TH AVE S, BIRMINGHAM, AL 35233-1711
(205) 939-9345
(205) 975-7307
Mailing address
703 VOLKER HALL, BIRMINGHAM, AL 35294-0001
(205) 939-9345
(205) 975-7307
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
25999
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009958245
—
AL
05
—
009958265
—
AL
Enumeration date
07/20/2006
Last updated
01/13/2011
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