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General NPI Number Information
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NPI Number | 1699128009
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Entity Type | Organization
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Legal Business Name | RIVER REGION DERMATOLOGY AND LASER INC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 2060 BERRYHILL RD
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City | MONTGOMERY
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State | AL
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Zip | 36117-8965
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Country | US
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Telephone | 334-416-8996
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Fax | 334-416-8997
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Provider Business Mailing Address
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Address Line | 1254 LAUREL BROOK LN
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City | MONTGOMERY
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State | AL
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Zip | 36117-8965
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Country | US
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Telephone | 334-416-8996
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Fax | 334-416-8997
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Authorized Official
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Title or Position | SOLE MEMBER OWNER
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Name | DR. PORCIA LOVE
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Credential | MD
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Telephone | 334-416-8996
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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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