Healthcare Provider Details

I. General information

NPI: 1508673773
Provider Name (Legal Business Name): ALABAMA SKIN CANCER & AESTHETIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 MONTGOMERY HWY STE 114
VESTAVIA HILLS AL
35216-2750
US

IV. Provider business mailing address

1360 MONTGOMERY HWY STE 114
VESTAVIA HILLS AL
35216-2750
US

V. Phone/Fax

Practice location:
  • Phone: 205-379-0900
  • Fax: 205-238-7900
Mailing address:
  • Phone: 205-379-0900
  • Fax: 205-238-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL J BERGMAN
Title or Position: OWNER
Credential: MD
Phone: 205-379-0900