NPIMap

Organization Active NPI

Gulf Coast Dermatology & Skin Care Centre PLLC

  • Dermatology Physician
  • Miramar Beach, FL
National Provider Identifier
1205174232
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GULF COAST DERMATOLOGY & SKIN CARE CENTRE PLLC
Practice address
7720 US Highway 98 W
Suite 340
Miramar Beach, FL 32550-7230
Phone
(251) 631-3570
Fax
(251) 631-3572
NPI assigned
Jan 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thomas W. Bender III, M.D.NPI 1649266792
Title
Owner
Phone
(251) 631-3570

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

7720 US Highway 98 W
Suite 340
Miramar Beach, FL 32550-7230

Mailing address

6701 Airport Blvd
Suite D232
Mobile, AL 36608-6705
Phone (251) 631-3570

Other names 1

  • Advanced Dermatology & Skin Care Centre PLLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Gulf Coast Dermatology Skin Care Centre PLLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6701 Airport Blvd
Ste D232
Mobile, AL 36608
Phone (251) 454-7955

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1205174232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD",
            "address_2": "SUITE D232",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086705",
            "telephone_number": "251-631-3570",
            "fax_number": "251-631-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7720 US HIGHWAY 98 W",
            "address_2": "SUITE 340",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325507230",
            "telephone_number": "251-631-3570",
            "fax_number": "251-631-3572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST DERMATOLOGY & SKIN CARE CENTRE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-25",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "BENDER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-631-3570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology & Skin Care Centre PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miramar Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.