Organization
DMMD CONCIERGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG MATTINGLY MD (OWNER)
(502) 361-8801
Entity
Organization
Contact information
Practice address
947 EASTERN PKWY, LOUISVILLE, KY 40217-1573
(502) 361-8801
(502) 361-8821
Mailing address
3202 THOUSAND OAKS DR, LOUISVILLE, KY 40205-2703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100646490
—
KY
Enumeration date
11/14/2019
Last updated
01/30/2020
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