| Name: | Bay Shore Dermatology, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 25 May 1994 (30 years ago) |
| Entity Number: | 000-164-692 |
| Register Number: | 000164692 |
| Historical Names: |
Bay Shore Dermatology, P.C.
Bay Shore Dermatology and Laser Surgery Center, P.C. |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 7550 ASSUNTA COURTFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE OF DERMATOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316011398 | 2006-11-20 | 2023-10-26 | 7550 ASSUNTA CT, FAIRHOPE, AL, 365323069, US | 7550 ASSUNTA CT, FAIRHOPE, AL, 365323069, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 251-928-4944 |
| Fax | 2519282086 |
Authorized person
| Name | DR. ROBERT CLARK |
| Role | PRESIDENT |
| Phone | 2519284944 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CLARK, ROBERT A | Agent |
| Name | Role |
|---|---|
| BLAUM, JANE MCCLURE MD | Incorporator |
| CLARK, ROBERT A MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2022-02-23 | Name Change | Bay Shore Dermatology and Laser Surgery Center, P.C. | Bay Shore Dermatology, PC |
| 1999-08-23 | Name Change | Bay Shore Dermatology, P.C. | Bay Shore Dermatology and Laser Surgery Center, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
