Provider Demographics
NPI:1023195393
Name:LASER AND SKIN CARE CENTER OF MOBILE
Entity Type:Organization
Organization Name:LASER AND SKIN CARE CENTER OF MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-433-7946
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-433-7946
Mailing Address - Fax:251-433-7778
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 303
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-433-7946
Practice Address - Fax:251-433-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021817207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty