Provider Demographics
NPI:1508673773
Name:ALABAMA SKIN CANCER & AESTHETIC CENTER LLC
Entity type:Organization
Organization Name:ALABAMA SKIN CANCER & AESTHETIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-379-0900
Mailing Address - Street 1:1360 MONTGOMERY HWY STE 114
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2750
Mailing Address - Country:US
Mailing Address - Phone:205-379-0900
Mailing Address - Fax:904-590-8291
Practice Address - Street 1:1360 MONTGOMERY HWY STE 114
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2750
Practice Address - Country:US
Practice Address - Phone:205-379-0900
Practice Address - Fax:205-238-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty