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General NPI Number Information
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NPI Number | 1932132768
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND SKIN CANCER SPECIALISTS, PSC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 3213 SUMMIT SQUARE PL STE 200
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City | LEXINGTON
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State | KY
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Zip | 40509-2652
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Country | US
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Telephone | 859-264-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 E PARRISH AVE BLDG E SUITE 205
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City | OWENSBORO
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State | KY
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Zip | 42303-1449
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Country | US
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Telephone | 270-852-1645
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JOHNATHON C. EDGE
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Credential | MD
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Telephone | 859-264-0557
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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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