East Louisville Dermatology, Psc
Dermatology in Louisville, KY. Organization (NPI-2).
NPI number1255468872
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1255468872
- Entity type
- Organization (NPI-2)
- Legal business name
- East Louisville Dermatology, Psc
- Organization subpart
- No
- Enumeration date
- Feb 28, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | 24086 | KY | Yes |
Practice location
4912 Us Highway 42Suite 208
Louisville, KY 40222-6349
Phone 502-426-9565 · Fax 502-425-3240
Mailing address
4912 Us Highway 42Suite 208
Louisville, KY 40222-6349
Phone 502-426-9565 · Fax 502-425-3240
Authorized official
Terrie S Williams
President
5024269565
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