Provider Demographics
NPI:1508097833
Name:BAY AREA LASER SKIN CARE CENTER
Entity Type:Organization
Organization Name:BAY AREA LASER SKIN CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:LYONS
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-706-1880
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:SUITE 3 C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1771
Mailing Address - Country:US
Mailing Address - Phone:251-706-1880
Mailing Address - Fax:251-344-5172
Practice Address - Street 1:3715 DAUPHIN ST
Practice Address - Street 2:SUITE 3 C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1771
Practice Address - Country:US
Practice Address - Phone:251-706-1880
Practice Address - Fax:251-344-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty