Healthcare Provider Details

I. General information

NPI: 1285833863
Provider Name (Legal Business Name): DIAGNOSTIC & MEDICAL ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SPRING HILL AVE SUITE 100
MOBILE AL
36604-1407
US

IV. Provider business mailing address

1700 SPRING HILL AVE SUITE 100
MOBILE AL
36604-1407
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-1200
  • Fax: 251-435-6357
Mailing address:
  • Phone: 251-435-1200
  • Fax: 251-435-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number26622
License Number StateAL

VIII. Authorized Official

Name: R BARRE SANDERS
Title or Position: VICE PRESIDENT
Credential:
Phone: 251-435-1200