Provider Demographics
NPI:1467843250
Name:DERMATOLOGY CENTER OF OWENSBORO PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER OF OWENSBORO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-663-1078
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLD E STE 205
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-663-1078
Mailing Address - Fax:
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLD E STE 205
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-663-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-15
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45100OtherMEDICAL LICENSE