Organization
PIKEVILLE DERMATOLOGY & COSMETIC CENTER, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY R LAVENDER D.O. (OWNER & PHYSICIAN)
(606) 432-9106
Entity
Organization
Contact information
Practice address
108 N AUXIER AVE, PIKEVILLE, KY 41501-9045
(606) 432-9106
(606) 432-0967
Mailing address
108 N AUXIER AVE, PIKEVILLE, KY 41501-9045
(606) 432-9106
(606) 432-0967
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
02627
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010250030
—
VA
05
—
5900011000
—
WV
05
—
64005812
—
KY
Enumeration date
05/09/2007
Last updated
06/11/2020
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