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General NPI Number Information
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NPI Number | 1326148701
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Entity Type | Organization
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Legal Business Name | PANACEA DERMATOLOGY, PA
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 321 E MAIN ST
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City | CHANUTE
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State | KS
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Zip | 66720-1836
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Country | US
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Telephone | 620-431-2273
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Fax | 620-431-4749
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Provider Business Mailing Address
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Address Line | 321 E MAIN ST
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City | CHANUTE
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State | KS
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Zip | 66720-1836
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Country | US
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Telephone | 620-431-2273
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Fax | 620-431-4749
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA C VETTER
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Credential | M.D.
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Telephone | 620-431-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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