Shelby Dermatology, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

00025681 Issued in AL

Legal business name

SHELBY DERMATOLOGY, PC

Practice address

1022 1St Street North
Suite 201
Alabaster, AL 35007

Phone

(205) 621-9500

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Robert Land Henderson Jr., M.D.NPI 1306833041

Title

President

Phone

(205) 621-9500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 3

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

• Robert Land Henderson Jr., MD

  • Dermatology Physician
  • Alabaster, AL
  • NPI 1306833041
  Medicare reassignment Care Compare group NPD Authorized official
• Gregory Bourgeois, M.D.

  • Dermatology Physician
  • Alabaster, AL
  • NPI 1073749677
  Medicare reassignment Care Compare group NPD
• Marian Elizabeth Northington, MD

  • Dermatology Physician
  • Birmingham, AL
  • NPI 1841220589
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740375856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 1ST STREET NORTH",
            "address_2": "SUITE 201",
            "city": "ALABASTER",
            "state": "AL",
            "postal_code": "35007",
            "telephone_number": "205-621-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 1ST STREET NORTH",
            "address_2": "SUITE 201",
            "city": "ALABASTER",
            "state": "AL",
            "postal_code": "35007",
            "telephone_number": "205-621-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LAND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-621-9500",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AL",
            "license": "00025681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51532549",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaneyfelt Counseling, LLC
• Shelby Baptist Ambulatory Surgery Center, LLC
• Shelby Baptist Health Center Endocrinology
• Shelby Baptist Sports Medicine and Family Medicine
• Shelby County Treatment Center
• Shelby Ear Nose and Throat
• Shelby Ear Nose and Throat PC, Associates
• Shelby Family Chiropractic LLC
• Shelby Family Eye Care, LLC
• Shelby Family Foot Clinic

• Specialist in Alabaster, AL
• Providers in Alabaster, AL by specialty
• Specialist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.