Organization
DERMATOLOGY ASSOCIATES OF DOTHAN, LLC
Active
Parent organization
DERMATOLOGY ASSOCIATES OF DOTHAN
Other names
Dermatology Associates of Dothan
Organization subpart
Yes
Provider details
NPI number
Legal business name
DERMATOLOGY ASSOCIATES OF DOTHAN
Authorized official
DR. TERRY L PYNES MD (OWNER)
(334) 793-9222
Entity
Organization
Contact information
Practice address
101 PROFESSIONAL LN, ENTERPRISE, AL 36330-2085
(334) 347-3404
(334) 671-0322
Mailing address
2431 W MAIN ST STE 501, DOTHAN, AL 36301-1274
(334) 793-9222
(334) 671-0322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8834
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51007184
BCBS OF ALABAMA
AL
05
—
529932951
—
AL
Enumeration date
01/27/2011
Last updated
01/27/2011
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