Provider Demographics
NPI:1174519623
Name:AVRAM, STEPHEN L (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:AVRAM
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 1:2040 2ND AVE E
Mailing Address - Street 2:SUITE A
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-2731
Mailing Address - Country:US
Mailing Address - Phone:205-274-9700
Mailing Address - Fax:205-274-9714
Practice Address - Street 1:2040 2ND AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2731
Practice Address - Country:US
Practice Address - Phone:205-274-9700
Practice Address - Fax:205-274-9714
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL013125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051545771OtherBCBS
AL051554535Medicaid
AL051521662OtherBCBS
AL009914076Medicaid
AL4046941OtherAETNA
AL009914076Medicaid
AL051554535Medicaid