Healthcare Provider Details

I. General information

NPI: 1649266792
Provider Name (Legal Business Name): THOMAS W BENDER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 PROVIDENCE PARK DR E 2ND FLOOR
MOBILE AL
36695-4614
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 251-631-3570
  • Fax: 251-631-3572
Mailing address:
  • Phone: 920-663-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME89393
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAL21520
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: