Organization
BLUEGRASS DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS M WILSON MD (OWNER)
(270) 443-7546
Entity
Organization
Contact information
Practice address
4616 VILLAGE SQUARE DRIVE, PADUCAH, KY 42001-7501
(270) 443-7546
(270) 443-4002
Mailing address
4616 VILLAGE SQUARE DRIVE, PADUCAH, KY 42001-7501
(270) 443-7546
(270) 443-4002
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
36202
KY
Other
Enumeration date
01/25/2007
Last updated
04/01/2011
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