Healthcare Provider Details

I. General information

NPI: 1902826118
Provider Name (Legal Business Name): VASCULAR SPECIALISTS OF MOBILE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3509
US

IV. Provider business mailing address

171 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3509
US

V. Phone/Fax

Practice location:
  • Phone: 251-432-0558
  • Fax: 251-432-0554
Mailing address:
  • Phone: 251-432-0558
  • Fax: 251-432-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number2086S0129X
License Number StateAL

VIII. Authorized Official

Name: MS. DEON LARTIGUE
Title or Position: PRACTICE MANAGER
Credential: CMM, CPC
Phone: 251-432-0558