Provider Demographics
NPI:1336271048
Name:KENTUCKY DERMATOLOGY OBS LONDON INC
Entity Type:Organization
Organization Name:KENTUCKY DERMATOLOGY OBS LONDON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-276-1511
Mailing Address - Street 1:1750 HIGHWAY 192 W
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2639
Mailing Address - Country:US
Mailing Address - Phone:859-276-1511
Mailing Address - Fax:859-276-3373
Practice Address - Street 1:177 BURT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2410
Practice Address - Country:US
Practice Address - Phone:859-276-1511
Practice Address - Fax:859-276-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical