Healthcare Provider Details

I. General information

NPI: 1932486651
Provider Name (Legal Business Name): LEXINGTON DERMATOLOGY & LASER CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 TATES CREEK CENTRE DR STE 202
LEXINGTON KY
40517-3094
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR STE 202
LEXINGTON KY
40517-3094
US

V. Phone/Fax

Practice location:
  • Phone: 859-226-0206
  • Fax: 859-226-0207
Mailing address:
  • Phone: 859-226-0206
  • Fax: 859-745-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH K PHILLIPS
Title or Position: OWNER
Credential: MD
Phone: 903-736-3337