Healthcare Provider Details

I. General information

NPI: 1063714012
Provider Name (Legal Business Name): IMC-CANCER SURGERY OF MOBILE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOBILE INFIRMARY CIR SUITE 305
MOBILE AL
36607-3520
US

IV. Provider business mailing address

3 MOBILE INFIRMARY CIR SUITE 305
MOBILE AL
36607-3520
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-5557
  • Fax: 251-433-5558
Mailing address:
  • Phone: 251-433-5557
  • Fax: 251-433-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD.24560
License Number StateAL

VIII. Authorized Official

Name: MR. ANTHONY PALAZZO
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 251-435-1361