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General NPI Number Information
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NPI Number | 1184078024
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Entity Type | Organization
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Legal Business Name | GULF COAST DERMATOLOGY & SKIN CARE CENTRE
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 580 PROVIDENCE PARK DR. EAST SUITE 202
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City | MOBILE
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State | AL
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Zip | 36695
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Country | US
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Telephone | 251-241-0071
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Fax | 251-202-9163
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Provider Business Mailing Address
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Address Line | 1620 W. NORTHWEST HIGHWAY SUITE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-572-0009
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Fax | 817-572-0221
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | DR. THOMAS BENDER
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Credential | M.D.
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Telephone | 251-241-0071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 114611
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License Number State | AL
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