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General NPI Number Information
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NPI Number | 1770734154
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND DERMATOLOGY SURGERY OF MOBILE PC
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 3153 DAUPHIN ST
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City | MOBILE
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State | AL
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Zip | 36606-4061
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Country | US
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Telephone | 251-445-8888
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Fax | 251-479-7164
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Provider Business Mailing Address
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Address Line | 3153 DAUPHIN ST
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City | MOBILE
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State | AL
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Zip | 36606-4061
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Country | US
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Telephone | 251-445-8888
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Fax | 251-479-7164
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTA SWAIN
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Credential | MD
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Telephone | 251-414-5810
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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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