Provider Demographics
NPI:1548432719
Name:MOBILE DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:MOBILE DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VANLOOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-635-1315
Mailing Address - Street 1:6163 OMNI PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5195
Mailing Address - Country:US
Mailing Address - Phone:251-635-1315
Mailing Address - Fax:
Practice Address - Street 1:6163 OMNI PARK DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5195
Practice Address - Country:US
Practice Address - Phone:251-635-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23602207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty