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General NPI Number Information
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NPI Number | 1508673773
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Entity Type | Organization
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Legal Business Name | ALABAMA SKIN CANCER & AESTHETIC CENTER LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 1360 MONTGOMERY HWY STE 114
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216-2750
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Country | US
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Telephone | 205-379-0900
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Fax | 205-238-7900
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Provider Business Mailing Address
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Address Line | 1360 MONTGOMERY HWY STE 114
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216-2750
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Country | US
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Telephone | 205-379-0900
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Fax | 904-590-8291
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL J BERGMAN
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Credential | MD
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Telephone | 205-379-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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