Organization
SKIN GROUP PLLC
Active
Organization
SKIN GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT H ZAX M.D. (PRESIDENT)
(502) 583-6647
Entity
Organization
Contact information
Practice address
2307 RIVER RD STE 101, LOUISVILLE, KY 40206-5000
(502) 583-6647
(502) 585-4824
Mailing address
PO BOX 36422, LOUISVILLE, KY 40233-6422
(502) 583-6647
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
25359
KY
363A00000X
Physician Assistant
PA1034
KY
363L00000X
Nurse Practitioner
4440P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18D0934789
CLIA NUMBER
KY
05
—
65938797
—
KY
05
—
78904968
—
KY
01
—
DA0326
RR MCR
KY
Enumeration date
04/06/2007
Last updated
10/09/2024
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