Organization
LOUISVILLE DERMATOLOGY ASC PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN THOMAS LOGSDON MD (DERMATOLOGIST OWNER)
(502) 363-1841
Entity
Organization
Contact information
Practice address
1700 BLUEGRASS AVENUE, SUITE 300, LOUISVILLE, KY 40215
(502) 363-1841
(502) 366-3317
Mailing address
1700 BLUEGRASS AVENUE, SUITE 300, LOUISVILLE, KY 40215
(502) 363-1841
(502) 366-3317
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50005707
PASSPORT
—
05
—
65943797
—
KY
Enumeration date
01/02/2007
Last updated
12/02/2013
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