Provider Demographics
NPI:1003869751
Name:CULLMAN DERMATOLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:CULLMAN DERMATOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-739-9711
Mailing Address - Street 1:1205 COUNTY ROAD 1466
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0795
Mailing Address - Country:US
Mailing Address - Phone:256-739-9711
Mailing Address - Fax:256-739-9737
Practice Address - Street 1:1205 COUNTY ROAD 1466
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0795
Practice Address - Country:US
Practice Address - Phone:256-739-9711
Practice Address - Fax:256-739-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18046207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC9291OtherRAILROAD MEDICARE
AL529700230Medicaid
ALE864Medicare PIN