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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