Organization
DEEP SOUTH DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN R STANFORD MD (OWNER)
(251) 621-2244
Entity
Organization
Contact information
Practice address
8573 COUNTY ROAD 64, DAPHNE, AL 36526-8706
(251) 621-2244
(251) 621-7209
Mailing address
PO BOX 40, DAPHNE, AL 36526-0040
(251) 621-2244
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00018113
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30930
AL BLUE CROSS
AL
Enumeration date
11/29/2006
Last updated
06/03/2008
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