Provider Demographics
NPI:1043851249
Name:PURE SKIN DERMATOLOGY & ONCOLOGY, INC
Entity Type:Organization
Organization Name:PURE SKIN DERMATOLOGY & ONCOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-684-7066
Mailing Address - Street 1:8331 MADISON BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2074
Mailing Address - Country:US
Mailing Address - Phone:256-684-7066
Mailing Address - Fax:
Practice Address - Street 1:8331 MADISON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2074
Practice Address - Country:US
Practice Address - Phone:256-684-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty