Organization
ASSOCIATE IN DERMATOLOGY AND DERMATOPATHOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAFAYETTE G OWEN MD (OWNER)
(812) 218-8927
Entity
Organization
Contact information
Practice address
1700 OLD BLUEGRASS AVE STE 200, LOUISVILLE, KY 40215-1174
(502) 361-3909
(502) 361-9229
Mailing address
1700 OLD BLUEGRASS AVE STE 200, LOUISVILLE, KY 40215-1174
(502) 361-3909
(502) 361-9229
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
13257
KY
Other
Enumeration date
10/17/2012
Last updated
04/18/2018
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