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General NPI Number Information
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NPI Number | 1538630751
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Entity Type | Organization
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Legal Business Name | SUNRISE DERMATOLOGY LLC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 8832 US HWY 90
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City | DAPHNE
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State | AL
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Zip | 36526
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Country | US
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Telephone | 251-289-1786
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Fax |
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Provider Business Mailing Address
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Address Line | 70 MIDTOWN PARK E
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City | MOBILE
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State | AL
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Zip | 36606-4140
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Country | US
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Telephone | 251-544-6407
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Fax | 251-544-6411
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SARAH WIERSZALOWSKI
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Credential |
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Telephone | 251-544-6407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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