Organization
RENEW FAMILY DERMATOLOGY LLC
Active
Other names
Renew Family Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
PAM MASON (MANAGER)
(256) 867-0851
Entity
Organization
Contact information
Practice address
212 AIRPORT ROAD W, FORT PAYNE, AL 35968
(256) 979-1250
(256) 979-1251
Mailing address
212 AIRPORT RD W, FORT PAYNE, AL 35968-3335
(256) 979-1250
(256) 979-1251
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236456
—
AL
Enumeration date
05/08/2019
Last updated
03/05/2026
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