Organization
REGIONAL DERMATOLOGY PLLC
Active
Organization
REGIONAL DERMATOLOGY PLLC
Active
Other names
Skin MD, SkinMD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL J PRUDEN II MD (PRESIDENT)
(859) 296-7546
Entity
Organization
Contact information
Practice address
989 GOVERNORS LN STE 220, LEXINGTON, KY 40513-1175
(859) 296-7546
(859) 721-0829
Mailing address
989 GOVERNORS LN STE 220, LEXINGTON, KY 40513-1175
(859) 296-7546
(859) 721-0829
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
34192
KY
207ND0900X
Dermatopathology Physician
34192
KY
207Y00000X
Otolaryngology Physician
34192
KY
208200000X
Plastic Surgery Physician
34192
KY
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
06/21/2017
Last updated
07/21/2022
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