| Name: | Deep South Dermatology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 21 Mar 1996 (29 years ago) |
| Entity Number: | 000-178-518 |
| Register Number: | 000178518 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | 12540 MARY ANN BEACH ROADFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
DERMATOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710054556 | 2006-11-29 | 2008-06-03 | PO BOX 40, DAPHNE, AL, 365260040, US | 8573 COUNTY ROAD 64, DAPHNE, AL, 365268706, US | |||||||||||||||||||||||||
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| Phone | +1 251-621-2244 |
| Fax | 2516217209 |
Authorized person
| Name | DR. ALAN R STANFORD |
| Role | OWNER |
| Phone | 2516212244 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 00018113 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AL BLUE CROSS |
| Number | 30930 |
| State | AL |
| Name | Role |
|---|---|
| STANFORD, ALAN | Incorporator |
| Name | Role |
|---|---|
| STANFORD, ALAN | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
