Provider Demographics
NPI:1376690339
Name:CANCER SURGERY OF MOBILE, P.C.
Entity Type:Organization
Organization Name:CANCER SURGERY OF MOBILE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:WALTON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-433-5557
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:STE 305
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-433-5557
Mailing Address - Fax:251-433-5558
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:STE 305
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-433-5557
Practice Address - Fax:251-433-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL245602086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH37904Medicare UPIN