Healthcare Provider Details

I. General information

NPI: 1508097833
Provider Name (Legal Business Name): BAY AREA LASER SKIN CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 DAUPHIN ST SUITE 3 C
MOBILE AL
36608-1771
US

IV. Provider business mailing address

3715 DAUPHIN ST SUITE 3 C
MOBILE AL
36608-1771
US

V. Phone/Fax

Practice location:
  • Phone: 251-706-1880
  • Fax: 251-344-5172
Mailing address:
  • Phone: 251-706-1880
  • Fax: 251-344-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUTH LYONS SHIELDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-706-1880