Mark  A  Stafford    MD
Contract Details
Facility name
Provider ID
P000001654
NPI
1841219748
Tax ID
630649108
Effective Date
4/1/1996
Last Updated
3/21/2013
Direct Contract
Yes
Term Date
3/21/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1201 11th Avenue South
Birmingham, AL 35205
United States
County
Jefferson
Phone
2059349999 (Phone)
Billing Details
Address
Specialty Type
Internal Medicine
Map
Address