Healthcare Provider Details

I. General information

NPI: 1932132768
Provider Name (Legal Business Name): DERMATOLOGY AND SKIN CANCER SPECIALISTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 SUMMIT SQUARE PL STE 200
LEXINGTON KY
40509-2652
US

IV. Provider business mailing address

2200 E PARRISH AVE BLDG E SUITE 205
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-0557
  • Fax:
Mailing address:
  • Phone: 270-852-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHNATHON C. EDGE
Title or Position: PARTNER
Credential: MD
Phone: 859-264-0557