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General NPI Number Information
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NPI Number | 1902302987
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Entity Type | Organization
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Legal Business Name | KENTUCKY SKIN CANCER CENTER PLLC
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 1818 WALLACE COURT SUITE 301
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone | 270-907-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 WALLACE COURT SUITE 301
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT SKAGGS II
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Credential | MD
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Telephone | 270-907-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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