Organization
GULF COAST DERMATOLOGY AND SKIN CARE CENTRE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS W. BENDER III MD (OWNER)
(251) 631-3570
Entity
Organization
Contact information
Practice address
29653 ANCHOR CROSS BLVD, DAPHNE, AL 36526-9594
(251) 631-3570
(251) 631-3572
Mailing address
6701 AIRPORT BLVD, SUITE D232, MOBILE, AL 36608-6705
(251) 631-3570
(251) 631-3572
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21520
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750614301
—
AL
Enumeration date
07/20/2011
Last updated
04/03/2013
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