Organization
DERMATOLOGY AND SKIN CANCER SPECIALISTS, PSC
Active
Organization
DERMATOLOGY AND SKIN CANCER SPECIALISTS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHON C. EDGE MD (PARTNER)
(859) 264-0557
Entity
Organization
Contact information
Practice address
3213 SUMMIT SQUARE PL STE 200, LEXINGTON, KY 40509-2652
(859) 264-0557
Mailing address
2200 E PARRISH AVE, BLDG E SUITE 205, OWENSBORO, KY 42303-1449
(270) 852-1645
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000489532
ANTHEM
KY
Enumeration date
07/07/2006
Last updated
06/03/2024
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