Organization
PANACEA DERMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA C VETTER M.D. (OWNER)
(620) 431-2273
Entity
Organization
Contact information
Practice address
321 E MAIN ST, CHANUTE, KS 66720-1836
(620) 431-2273
(620) 431-4749
Mailing address
321 E MAIN ST, CHANUTE, KS 66720-1836
(620) 431-2273
(620) 431-4749
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111207
BLUE CROSS BLUE SHIELD
KS
01
—
DE3179
RAILROAD MEDICARE
IA
Enumeration date
09/25/2006
Last updated
08/22/2020
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