Healthcare Provider Details

I. General information

NPI: 1184078024
Provider Name (Legal Business Name): GULF COAST DERMATOLOGY & SKIN CARE CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 03/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 PROVIDENCE PARK DR. EAST SUITE 202
MOBILE AL
36695
US

IV. Provider business mailing address

1620 W. NORTHWEST HIGHWAY SUITE 100
GRAPEVINE TX
76051
US

V. Phone/Fax

Practice location:
  • Phone: 251-241-0071
  • Fax: 251-202-9163
Mailing address:
  • Phone: 817-572-0009
  • Fax: 817-572-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number114611
License Number StateAL

VIII. Authorized Official

Name: DR. THOMAS BENDER
Title or Position: MANAGING OFFICER
Credential: M.D.
Phone: 251-241-0071