Organization Name: | GREATER MOBILE LASER & AESTHETIC |
NPI Number: | 1437593423 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD F HWANG (MEDICAL DIRECTOR) |
Mailing Address: | 4402b Old Shell Rd Mobile |
State: | AL US |
Postal Code: | 366081912 |
Phone Number: | 2514457546 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2013 |
NPI Last Update Date: | 04/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |