Provider Demographics
NPI:1487663266
Name:BROOKWOOD DERMATOLOGY, PC
Entity Type:Organization
Organization Name:BROOKWOOD DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-824-4441
Mailing Address - Street 1:521 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1878
Mailing Address - Country:US
Mailing Address - Phone:205-824-4441
Mailing Address - Fax:205-822-3978
Practice Address - Street 1:521 MONTGOMERY HWY
Practice Address - Street 2:SUITE 117
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1878
Practice Address - Country:US
Practice Address - Phone:205-824-4441
Practice Address - Fax:205-822-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ304Medicare ID - Type Unspecified