Louisville Dermatology Asc Psc

NPI #1669539789 in Louisville, Kentucky

Provider Information

NPI Number: 1669539789
Entity Type: Organization
Organization Name: Louisville Dermatology Asc Psc
Primary Specialty: Dermatology
Enumeration Date: Jan 2, 2007
Last Updated: Dec 2, 2013

Practice Location

Address: 1700 BLUEGRASS AVENUE
Address 2: SUITE 300
City: Louisville
State: Kentucky
ZIP Code: 40215
Phone: (502) 363-1841

Authorized Official

Name: MARTIN THOMAS LOGSDON, MD
Title: DERMATOLOGIST OWNER
Phone: (502) 363-1841

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X
Dermatology	207N00000X	Primary

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