| Name: | Dermatology and Dermatology Surgery of Mobile, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 22 Sep 2008 (16 years ago) (Companies founded in September 2008) |
| Date of dissolution: | 17 Sep 2021 |
| Entity Number: | 000-258-764 |
| Register Number: | 000258764 |
| ZIP code: | 36606 (Companies in Mobile, 36606) |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 3153 DAUPHIN STREETMOBILE, AL 36606 |
| Authorized Capital: | $5,000 |
Activities
MEDICAL PRACTICE (DERMATOLOGY)
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770734154 | 2008-10-03 | 2015-11-24 | 3153 DAUPHIN ST, MOBILE, AL, 366064061, US | 3153 DAUPHIN ST, MOBILE, AL, 366064061, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 251-445-8888 |
| Fax | 2514797164 |
Authorized person
| Name | ROBERTA SWAIN |
| Role | OWNER |
| Phone | 2514145810 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 510G70048 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
| Number | 51594108 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | 510G70048 |
| State | AL |
| Name | Role |
|---|---|
| SWAIN, ROBERTA | Agent |
| Name | Role |
|---|---|
| SWAIN, ROBERTA | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
