Healthcare Provider Details

I. General information

NPI: 1376690339
Provider Name (Legal Business Name): CANCER SURGERY OF MOBILE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3 MOBILE INFIRMARY CIR STE 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 Number24560
License Number StateAL

VIII. Authorized Official

Name: DR. LEE WALTON THOMPSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 251-433-5557