NPIMap

Organization Active NPI

Gulf Coast Dermatology & Skin Care Centre PLLC

  • Dermatology Physician
  • Mobile, AL
National Provider Identifier
1891179727
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
21520 Issued in AL
Legal business name
GULF COAST DERMATOLOGY & SKIN CARE CENTRE PLLC
Doing business as
Advanced Dermatology & Skin Care Centre
Practice address
6701 Airport Blvd Ste D232
Mobile, AL 36608-6757
Phone
(251) 631-3570
Fax
(251) 631-3572
NPI assigned
Jul 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

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

Authorized official

Name
Dr. Thomas W Bender III, MDNPI 1649266792
Title
Physician
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 21520 AL Primary

Addresses

Primary practice location

6701 Airport Blvd Ste D232
Mobile, AL 36608-6757

Mailing address

PO Box 850489
Ste. D232
Mobile, AL 36685-0489
Phone (251) 631-3570

Other identifiers 1

IdentifierTypeStateIssuer
116224MedicaidAL

Other names 1

  • Advanced Dermatology & Skin Care Centre Doing business as

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.

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": "1436400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436400000000",
    "number": "1891179727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850489",
            "address_2": "STE. D232",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366850489",
            "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": "6701 AIRPORT BLVD STE D232",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086757",
            "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": "2015-07-09",
        "last_updated": "2015-07-09",
        "status": "A",
        "authorized_official_last_name": "BENDER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "251-631-3570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AL",
            "license": "21520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116224",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology & Skin Care Centre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; 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.