Healthcare Provider Details

I. General information

NPI: 1215042429
Provider Name (Legal Business Name): ARTIS P. TRUETT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 NEW HARTFORD RD
OWENSBORO KY
42303-1320
US

IV. Provider business mailing address

2821 NEW HARTFORD RD
OWENSBORO KY
42303-1320
US

V. Phone/Fax

Practice location:
  • Phone: 270-685-5777
  • Fax: 270-685-0190
Mailing address:
  • Phone: 270-685-5777
  • Fax: 270-685-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number32162
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number32162
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number32162
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number32162
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number32162
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number32162
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: